GOP health bills threaten ‘havoc’
Impact likely to reach far beyond 50M uninsured
WASHINGTON — Congressional Republicans, who for years blasted the Affordable Care Act for disrupting Americans’ health care, are now pushing changes that threaten to not only strip health coverage from millions, but also upend insurance markets, cripple state budgets, and drive clinics and hospitals to the breaking point.
President Donald Trump and GOP leaders have touted their Obamacare repeal bills — one passed by the House last month and a Senate version unveiled last week— as a necessary fix to problems created by the Affordable Care Act. But in physicians’ offices and medical centers, in state capitals and corporate offices, there are growing fears the unprecedented cuts proposed in the GOP legislation create even larger problems in the U.S. health care system.
“These reductions are going to wreak havoc,” warned Thomas Priselac, chief executive of CedarsSinai Health System in Los Angeles, one of the country’s leading medical centers. “It will be a tragic step backward not just for the people most affected, but for the country as a whole.”
Trump sounded a different note in his weekly radio address Saturday, pledging anew to save Americans from rising health care costs he blames on Obamacare. “The American people are calling out for relief, andmy administration is determined to provide it,” he said.
Even supporters of Obamacare acknowledge the current law needs adjustments, especially to insurance markets, where premiums have risen sharply in recent years and many insurers have pulled out.
But there are few indications the GOP repeal bills will bring much stability.
The nonpartisan Congressional Budget Office estimated the House repeal bill, which Trump celebrated last month only to later call it “mean”, would nearly double the number of Americans without health coverage over the next decade, pushing the ranks of the uninsured to more than 50 million.
And the Senate bill, which includes even deeper cuts over time, is unlikely to be much less disruptive. The cascading effects of such a retrenchment will reach far beyond those who lose coverage, according to doctors, hospital leaders, insurance executives, patient advocates and state officials across the country. To date, no leading patient group or physician organization has supported the GOP repeal bills.
Governors and state legislators, facing huge reductions in federal Medicaid funding, may have to decide whether to reduce services, limit who can enroll in the health care safety net or make cuts to other state programs. On Friday, Nevada Gov. Brian Sandoval, a Republican who expanded his state’s Medicaid program through Obamacare, warned that the Senate bill would cost Nevada nearly $500 million. “That’s a cost that the state cannot sustain,” he said.
And though the Medicaid cuts may be phased in over several years, many states that have two-year budgets would have to confront the cuts sooner.
Overall, the House bill slashes more than $800 billion in federal Medicaid spending over the next decade, according to the CBO, slashing close to a quarter of federal aid for a program that now covers more than 70 million poor Americans. The extent of the cuts in the Senate bill is unclear, but the Senate version caps federal Medicaid spending evenmore aggressively over time than the House legislation, fundamentally changing the program’s historic coverage guarantee. Over the past half-century, the federal government has paid a share of all medical costs incurred by Medicaid patients. But under the GOP plans, that funding would be replaced by fixed payments to states, regardless of what it costs to care for patients. Because that cap would only increase at the rate of inflation under the Senate plan, states may bear a larger and larger share of medical costs, which have historically increased faster than inflation.
In addition to the Medicaid reductions, both the House and Senate repeal bills would dramatically scale back financial assistance to low- and moderateincome Americans who buy health plans on Obamacare marketplaces. Those cuts would make health coverage substantially more expensive for many consumers, forcing some to drop insurance, independent analyses have concluded.
The coverage losses, in turn, will put new pressures on doctors, clinics and hospitals as they face growing numbers of patients with no insurance who are unable to pay their medical bills.
And the strain will reach beyond the health care system. Employers, who provide health coverage to more than 150 million workers and their families, could see their costs rise as hospitals and physicians try to make up for losses they incur caring for more uninsured patients.
It also will likely hit employees, who will see insurance premiums increase and wages stagnate as businesses shift costs.
Insurance markets, too, could see turmoil as states eliminate national standards in the current law that dictate all plans must cover basic benefits and cannot charge sick patients more.