The revised U.S. Senate health care legislation, released Thursday, shows some significant changes from the earlier version that ran into political roadblocks.
The new draft bill would let insurers sell stripped-down, cheaper health plans that don’t comply with current benefit requirements, such as coverage of maternity and mental health care.
The revised legislation provides an additional $70 billion to help states lower the cost of insurance for their residents through cost-sharing plans or allowing people to use health savings accounts to pay their premiums. That money would be added to the more than $100 billion in the original bill.
It would also increase the amount of funding for opioid addiction programs from $2 billion to $45 billion.
And it would help the 19 states, including Georgia, that have not expanded their Medicaid programs under the Affordable Care Act, by creating a new formula for indigent care funding that’s favored by the Georgia Hospital Association.
The hospital group said that under that shift, Georgia would be eligible for roughly an additional $250 million as compared to the earlier Senate bill, beginning in fiscal 2020.
The new bill would continue Medicaid coverage for children with “medically complex disabilities,” a provision sought by Georgia’s U.S. senators.
The new Senate proposal, like its predecessor, would still eliminate the ACA requirement for individuals to have health coverage and for employers to cover their workers.
It also aims to phase out Medicaid expansion and moves the government program from an open-ended entitlement to a structure that limits federal funding. It would allow states to choose between block grants and per capita allotments for low-income residents on Medicaid.
In the event of a public health emergency, state Medicaid spending in a particular part of a state would not be counted toward the spending limits, the New York Times reported.
Republicans have long vowed to “repeal and replace” the current federal health law, known as the the Affordable Care Act, or Obamacare. With their party now in control of both Congress and the White House, the chances of that happening this year seemed high. But the process has been contentious.
Congressional Democrats oppose any weakening of the ACA. And some GOP legislators, such as Sen. Rand Paul of Kentucky, complain that the House and Senate versions of a potential new health bill would leave parts of Obamacare in place.
The new Senate version, for instance, would preserve Obamacare taxes for high-earners but repeal those levies on the health care industry, such as drug manufactures and medical device makers. Both of the high-earner taxes would have been repealed under the previous Senate bill.
And the latest Senate proposal keeps the earlier version’s provision that could give financial break to low-spending Medicaid states, like Georgia, by allowing them extra funding. (Here’s a GHN article on the redistribution formula.)
The fate of the new Senate plan is uncertain. The proposal has not yet been scored by the Congressional Budget Office, which said the earlier Senate plan would lead to 22 million more Americans to not have health insurance. That would include an estimated 680,000 Georgians.
Separately, Sens. Lindsey Graham (R-S.C.) and Bill Cassidy (R-La.) said Thursday they are working with their GOP colleagues on an alternative approach to replacing Obamacare. Their plan, they said, would keep federal taxes from the ACA in place and sending that money to the states to control.
Graham told CNN that states could keep Obamacare in place or replace it with a new system.
The Cruz proposal
One of the more contentious provisions in the bill unveiled Thursday is a proposal pushed by Sen. Ted Cruz (R-Texas) that would let insurers sell less comprehensive plans if they also offered at least one option that complied with current federal standards. The stripped-down plans could drop certain types of coverage, such as maternity or mental health and substance abuse care.
Conservatives say this idea would allow younger and healthier people to buy cheaper plans.
“What it is focused on, front and center, is lowering premiums,” Cruz said of his amendment, according to the Washington Post. “You the consumer, should have the freedom to purchase the insurance you want.”
But experts warn that sick people would be the only ones left in the more expensive, comprehensive Obamacare plans, spiking those premiums. America’s Health Insurance Plans, an industry trade group, has criticized the Cruz proposal as potentially hurting people with pre-existing conditions because they would see fast-rising premiums.
Patient advocacy groups, including the Atlanta-based American Cancer Society’s Cancer Action Network, blasted the Cruz proposal in a joint letter.
“We are deeply concerned about an amendment [that] could create serious access and affordability problems for any person with a pre-existing health condition, chronic disease or disability,’’ the groups said. “Older or sicker individuals would overwhelmingly choose ACA-compliant plans because they follow rules that protect people with pre-existing conditions and contain benefit standards, limits on catastrophic out-of-pocket costs, and a prohibition on setting premiums based on health status.
“Without the younger, healthier people in the risk pool, the premiums for ACA-compliant plans would rise quickly and significantly.”
Cindy Zeldin of consumer advocacy group Georgians for a Healthy Future said that the new bill “still raises red flags for consumers. The deep cuts to Medicaid, weakening of consumer protections, and destabilizing of insurance markets would diminish coverage, access and affordability for Georgians.”
The American Hospital Association pointed out Thursday that “there are no significant changes to the massive Medicaid reductions” in the new Senate bill. And Ethan James of the Georgia Hospital Association said, “We have many, many concerns about the massive Medicaid cuts and the number of additional uninsured.” James added that the change in indigent care funding, though, was “a break in the clouds, compared to the rest of the bill.”
The revised bill’s provision to allow people with health savings accounts to use those funds to pay their insurance premiums “would help increase coverage,’’ said Bill Custer, a health insurance expert with Georgia State University, on Thursday.
Custer added, though, that he did not expect the new Senate legislation overall would lead to more people retaining insurance. The added indigent care money would go to hospitals, not to people needing coverage, he said.
And the Cruz proposal would “further segment’’ the insurance market, while the added stabilization funds for states “are probably not adequate’’ to offset costs of covering people with medical conditions, Custer said.
The current House and Senate proposals, Custer said, would give states “more control and responsibility – both fiscally and administratively – on both Medicaid and private insurance.”
Many insurance industry officials, meanwhile, favor the legislation’s intent to give more control over regulations to the states.
Graham Thompson, of the Georgia Association of Health Plans, said Thursday that insurers would welcome a shift to more state regulatory power over insurance. Thompson said his organization has not taken a position on the Senate bill.
Senate Majority Leader Mitch McConnell (R-Ky.) has said he wants a vote on the legislation next week.
President Trump weighed in publicly Wednesday, telling Christian Broadcasting Network founder Pat Robertson in an interview that he wants Congress to send him a health care bill to sign.
“I will be very angry about it and a lot of people will be very upset” if no bill is passed, Trump said. Referring to McConnell, Trump added, “Mitch has to pull it off. He’s working very hard.”