Washington – Connecticut’s senators blasted the GOP plan to repeal and replace the Affordable Care Act, but will sit on the sidelines as their divided Republican colleagues try to hash out final details of a “discussion draft” released Thursday.
Senate Majority Leader Mitch McConnell hopes for a vote on the plan next week, but said he’s willing to make changes to win over balky senators from both the moderate and conservative ends of the GOP spectrum.
“Seven years ago Democrats imposed Obamacare on our country,” McConnell said. “They said it would lower costs. It didn’t. From 2013 to 2017 premiums on the average have doubled…Does it seem like Obamacare is working? We are going to provide better health care.”
The bill, which will need 50 votes for approval, is not expected to win any Democratic support. Still, Democrats are doing everything possible to stir public sentiment against it.
“No tweaks by amendment can fix this monstrosity. If you vote for this evil, intellectually bankrupt bill, it will ruin millions of lives,” Sen. Chris Murphy tweeted immediately upon the release of the bill Thursday.
Sen. Richard Blumenthal said, “This measure is simply mean.” He also said “it will literally cost American lives,” because it would make affordable insurance coverage unattainable for many.
“Republicans in the Senate have made mere cosmetic touches to the House’s cruel and costly healthcare bill,” he said. “Nips and tucks fail to reshape this reprehensible plan into anything approaching responsible legislation.”
Blumenthal said, “The bill guts Medicaid – throwing children and families who rely on this critical program to the wolves. Seniors will see skyrocketing costs, if they are able to receive coverage at all under this heartless plan.”
Gov. Dannel Malloy also joined the chorus of Democratic denunciations of the bill, saying “make no mistake, people will needlessly die under this plan.”
“Republicans in the Senate had an opportunity to reject the disastrous bill that passed the U.S. House of Representatives and work together with Democrats to build on the successes of the Affordable Care Act. Instead, they chose to double down on Trumpcare – which is as cruel as it is dangerous,” the governor said in a statement. “Millions will lose coverage. Premiums will go up. Those with pre-existing conditions will be priced out of coverage. Medicaid will be eviscerated.”
The bill was drafted by 13 Republican senators, without input from Democrats – or even most of the Republicans in the Senate – or committee hearings.
To underscore the secretive nature of the process, Murphy this week took a cab ride with two other Democratic senators to the Congressional Budget Office, which will give its assessment of the bill’s cost and impact on coverage in the coming days. The Democratic senators were on a mission to try to find the bill, but Murphy said he was not surprised the CBO declined to release it.
Although he wants a quick vote on the bill, McConnell will have a tough time corralling support.
Conservative Republican Sens. Ted Cruz of Texas, Ron Johnson of Wisconsin, Mike Lee of Utah, and Rand Paul of Kentucky said they are “not ready” to support the plan. But they said in a statement that they remained open to voting for it after further negotiations.
Keeps some subsidies, cuts Medicaid
The bill adopts many provisions of the American Health Care Act approved by the U.S. House of Representatives last month.
But it also would keep key ACA benefits, including subsidies to help low- and moderate-income Americans purchase insurance.
ACA subsidies would remain the same until 2020, when they would be capped for individuals and families who earn no more than 350 percent of the federal poverty level. Under the ACA, the cap is 400 percent of the federal poverty level.
Subsidies in the Senate bill also would mirror the ACA in that they would be pegged to a benchmark insurance plan each year, so that subsidies would grow as the cost of that insurance plan rises.
The Senate bill also would keep the ACA’s Medicaid expansion around longer, gradually phasing it out over three years, starting in 2021.
Under the Affordable Care Act, Connecticut dramatically increased the number of individuals covered under Medicaid, known as HUSKY in the state, by about 170,000 individuals.
But the Senate bill combined with Connecticut’s fiscal woes raised fears those individuals could eventually lose coverage. In the long run, the Senate bill would cut Medicaid more deeply than the AHCA.
In 2021, the Senate bill would transform Medicaid, or HUSKY, from an open-ended entitlement program to a system based on per-capita enrollment. That means federal contributions to the program, which is jointly funded with the states, would be limited, and in 2025 increases in the federal contribution would be based on the general inflation index. The House plan would base increases on the more generous medical inflation index.
The bill would give Connecticut the same federal reimbursement rate — now at 90 percent — for those on the expended Medicaid program through 2019. But the higher rate for those Medicaid expansion patients would fall in each of the subsequent years. By 2024 that reimbursement rate would drop to 50 percent, the same rate the federal government pays Connecticut in its core Medicaid, or HUSKY, program.
“It goes to the same bad place as the House bill, but takes a slightly different path,” said Ellen Andrews, executive director of the Connecticut Health Policy Project, of the Senate bill’s Medicaid provisions.
Jeffrey Gordon, president of the Connecticut State Medical Society, said he is concerned the state won’t be able to afford to provide coverage for the tens of thousands of people who benefited from the expanded Medicaid program.
“It relied solely on federal money for the expansion,” he said. “Connecticut would lose that Medicaid money and given its budget crisis would no longer be able to continue that expansion.”
Less federal Medicaid money means benefits for others also might be cut, and the uncertainty about what Connecticut would do worries HUSKY patients.
Pat Whittel, 55, a HUSKY beneficiary who lives in West Hartford and works as a high school teaching assistant, says she’s concerned about any cuts the state might make to the program.
Whittel says she suffers from bipolar disorder and her coverage now covers all of her needs.
“I get the services I need and I’m doing great, but if I lose those services, I won’t,” she said.
Shifts responsibility to states
The full impact of the Senate health care bill is difficult to determine because it aims to shift much of the responsibility for helping Americans secure health care coverage from the federal government to the states.
However, the Senate bill backs away from some last-minute House concessions to conservatives that would have allowed states to opt out of several protections for those with pre-existing conditions.
Still, Deb Polun, a lobbyist with the Community Health Center Association of Connecticut, said the bill would allow insurers to charge older Americans up to five times the premium charged younger Americans. The ACA capped it at three times.
“Our guiding principle right now is ‘do no harm,’ Polun said. “This bill doesn’t follow that principle.”
Polun said she also is concerned about the proposed cuts to Medicaid and possible reductions in the subsidies for those who purchase insurance through Access Health CT, Connecticut’s Obamacare exchange.
About 73,000 Connecticut residents use ACA subsidies to purchase insurance coverage.
Polun said 31 percent of HUSKY patients use community health centers in the state for thier care.
HUSKY patients also frequent Planned Parenthood clinics in the state. The Senate health bill would prohibit Medicaid/HUSKY patients form using Planned Parenthood clinics. That defunding is based on GOP opposition to Planned Parenthood’s abortion services, even though existing federal law bars Medicaid from paying for abortions unless a pregnancy is the result of incest or rape or could endanger the life of a mother.
Republicans say Medicaid patients can get care at clinics that don’t offer abortion services. But Polun said “it is not clear if we have the capacity to take care of all of the Planned Parenthood patients.”
The Senate bill would leave Obamacare basically intact for 2018 and 2019 and would shore up the existing ACA state marketplaces by allocating funds for the cost-sharing reduction subsidies that help low- and moderate-income Americans pay for out-of-pocket costs like co-pays and deductibles. This will placate insurers, who were distraught over President Donald Trump’s refusal to commit to continuing these payments, leading many carriers to hike rates or drop out of the exchanges for 2018.
The House health bill would not fund the CSR payments.
ConnectiCare and Anthem, the two remaining insurers on Access Health, said they will base their decision on whether to continue to sell policies on the exchange in part on the fate of the CSR payments.
Insurers will also be gladdened by the end of ACA taxes on insurance policies. Taxes levied on wealthier Americans to fund Obamacare also would be repealed.
But the Senate bill would end the ACA requirement that most Americans be covered by insurance. Insurers say that the “individual mandate” is needed to keep younger, healthier people in the market and keep down rates.
Like the House health care bill, the Senate bill would provide states billions of dollars in grants to shore up their health care system.
The Senate bill also would give states more leeway in opting out of the ACA’s mandate that insurers provide “essential health benefits” that include mental health and maternity care through the use of “Section 1332” waivers in the Affordable Care Act. States could use the waivers to make federal subsidies available even off the marketplaces, a move some states like Iowa already are considering because they may not have any insurers in their ACA marketplaces in 2018.