Governors wary of Medicaid cost shift in Senate health bill

Monday, 26 Jun, 2017

The spotlight is even more focused on four conservative Republican senators who say that they can not vote for the bill as it stands now.

The measure largely uses people's incomes as the yardstick for helping those without workplace coverage to buy private insurance.

The top reason Obamacare has failed to keep insurance premiums down is simple: the ACA requires insurance companies to provide more expensive plans filled with so-called "essential benefits". The 142-page bill has numerous same provisions as the version that the House passed last month, but it comes with some key differences as well.

In addition to the proposed Medicaid cuts, the Senate follows the Trump administration's budget guidance to eliminate the Prevention and Public Health Fund, which accounts for a significant portion of the budget for the Centers for Disease Control and Prevention.

The bill would cut and redesign the Medicaid program for low-income and disabled people, and erase taxes on higher earners and the medical industry that helped pay for the roughly 20 million Americans covered by Obama's law. Those higher prices will drive out more customers who either don't believe they need coverage or can't afford it because the legislation's tax credits aren't generous enough and the insurance policies they can buy are so skimpy as to be unappealing.

Mr McConnell is reportedly looking to schedule a vote on the bill sometime before the 4 July Congressional recess, which does not give much time to deliver what Mr Obama called "the kind of leadership that appeals to Americans across party lines".

The new bill would maintain premium subsidies created under the ACA, although eligibility criteria would be tightened up starting in 2020, when the threshold for support would be reduced from 400% of the poverty level to 350%.

Nevertheless, Senate Republicans will claim that their bill repeals ObamaCare and replaces it with free-market reforms.

The expansion has provided coverage to 11 million people in the 31 states that accepted it. The House bill went with relying exclusively on age, but like the ACA, the Senate version also considers a person's income and geography.

That would ease costs for younger people, but increase them for the older people on fixed incomes.

The uncertainty and outright opposition put the bill short of the 50 votes needed to pass - only two Republicans can defect, since Democrats plan to universally oppose it. But the savings will be enormous when compared to what keeping people with pre-existing conditions in the general insurance population is costing everyone.

House bill: State could allow insurers to raise premiums based on pre-existing conditions if they had a gap in coverage. Payers would be able to charge older beneficiaries five times more than younger ones, instead of three times more as now allowed. Previously, the CBO said that the House bill would cause the number of insured to drop by 23 million by 2026.

Senate bill: Insurers could charge older people up to 5 times more. Meanwhile, it nearly doubles the amount that individuals and families can set aside tax-free in a Health Savings Account for routine medical expenses. Now don't be fooled, funding these risk pools and making them effective will not be cheap.

In its statement, ASCO said the bill would not go far enough to provide high quality care to Americans who need it.

The bill does include $2 billion in fiscal 2018 to help states address the opioid epidemic. The Senate would explicitly fund them, to the tune of $7 billion a year through 2019. All the taunts over conservative obstruction, all the insistences that a federally administered entitlement could never be reduced, must sound like a fight song to most Republicans as they near the summit. It would reduce the rate of growth in traditional Medicaid spending, but Medicaid spending would still grow, year after year, forever. Chris Collins and John Faso, looks to shift $2.3 billion in Medicaid costs from counties to the state - and only in NY.

The next step, then, is for the states to reject any attempt by the federal government - regardless of the party affiliation of the act's authors - to impose upon them any programs or policies associated with the healthcare provided within them.

"Legislation is too often shoved through Congress without proper hearings, amendments, or debate, as the secrecy surrounding the Senate's health care bill and the pressure to vote for it with little time to fully evaluate the proposal once again remind us", Paul wrote in a statement published Wednesday.

Among the provisions the House and Senate bills agree on are big changes to what insurance is required to cover.