Senate Republicans have introduced a healthcare bill that would revise many of the changes imposed by the Patient Protection and Affordable Care Act (ACA), cutting federal support for Medicaid and repealing the individual and employer mandates for having and providing insurance. In a statement, ASCO the nation’s largest association of oncologists, said the bill falls short of healthcare needs and should be reformulated in a bipartisan forum.
GOP Majority Leader Mitch McConnell (R-Ky) described the bill as shifting more control over healthcare spending to states and stabilizing insurance markets that he said are foundering under the ACA . “This will ultimately transition away from Obamacare’s collapsing system entirely, so more Americans won’t be hurt,” he said.
The bill’s arrival in the Senate follows the May approval of a House version by a vote of 217 to 213. The Senate bill was immediately attacked as having been formulated in secrecy without any public discussion. McConnell is expected to push for a vote before the July Fourth recess. Assuming none of the Senate Democrats support the bill, as is expected, at least 50 of the 52 Senate Republicans would need to vote in favor to achieve passage.
In its statement, ASCO said the bill would not go far enough to provide high quality care to Americans who need it. “We are disappointed that what the Senate has put forth does not ensure that more Americans, especially those with serious and life-threatening diseases like cancer, would be able to receive high-quality health care,” said ASCO chief executive officer Clifford A. Hudis, MD. “ASCO supports legislation that adheres to our previously shared principles for health reform, and we urge the full Senate to go back to the drawing board and work in a bi-partisan fashion to provide an alternative that in particular provides key protections for patient access to critical cancer care.”
McConnell has defended the openness of the bill’s formulation, contending that although opponents contend the Senate vote will come too soon for enough debate, “We’ve been discussing all the elements of this for 7 years. Everybody pretty well understands it.”
Senate Democrats asked for more time for review of the healthcare measure, without success.
Minority Leader Chuck Schumer (D-NY) described the legislation as potentially reducing Medicaid coverage more deeply than the House bill. “This bill is designed to strip away protections from Americans who need it most in order to give a tax break to the folks who need it least,” he said. “The way this bill cuts healthcare is heartless.”
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%. However, subsidies would be expanded to residents of states that didn’t see an expansion of Medicaid support. Similar to the House version, the Senate bill would withdraw funding from Planned Parenthood.
The waivering Republicans are expected to be influenced in their votes by the soon-expected release of a Congressional Budget Office report that would estimate the cost of the legislation and the number of Americans who would lose coverage under the plan. Previously, the CBO said that the House bill would cause the number of insured to drop by 23 million by 2026.
The Senate bill would allow Medicaid funding extended under the ACA to remain in place through 2021, a year longer than the House version of the bill. After 2021, the expansion funding would be phased out over 3 years.
The House plan to send Medicare money to states each year via block grants or based on enrollment remains in the Senate version. However, the growth rate of that money would be restricted to the rate of average inflation rather than rapidly expanding medical inflation. Medicaid funding would be restored to pre-ACA levels by 2024.
Among other controversial points, the Senate version would preserve coverage protections for people with preexisting conditions. The bill also factors in age, income, and geography when determining how much financial assistance people would receive to help with their premiums, which is consistent with the ACA structure, though different from the GOP House version, which would factor in age but not income.
The bill does include $2 billion in fiscal 2018 to help states address the opioid epidemic.