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Weiss: GOP Health Care Reform Moves to Senate

Monday, May 08, 2017

 

Paul Ryan

House Speaker Paul Ryan’s words are now coming back to haunt him and GOP leadership that rammed American Health Care Act (AHCA), without procedural safeguards, through the House chamber days ago.  “I don’t think we should pass bills that we haven’t read that we don’t know what they cost,” said Ryan in a 2009 interview on MSNBC when Congress was debating President Obama’s 1990-page Affordable Care Act (ACA), or Obamacare. 

Last month, the Trump Administration efforts to repeal and replace Obamacare, with the AHCA went down in flames when so many GOP moderates and conservative House lawmakers opposed the bill that the leadership didn’t dare bring it up for a vote.  Successful negotiations of the GOP factions crafted a new version that passed last Thursday by a razor-thin vote of 217-213, a slim margin of four votes.  All 193 Democrats opposed passage, along with 20 Republican lawmakers. With House passage, the bill moves to the Senate for deliberation. 

Before the House vote on the GOP health bill there were no legislative hearings held to debate its merits and its full text was posted on the Web less than 24 hours before the vote.  Ryan did not even wait for the nonpartisan Congressional Budget Office (CBO) to provide an updated financial analysis of AHCA. The CBO’s analysis of the original bill, pulled moments before a scheduled vote on March 24, 2017, found that the GOP health care proposal estimated that if passed 24 million or more Americans could be uninsured by 2026.

Opposition Mounting to GOP Health Care Proposal

With the passage of AHCA, Democratic Policy and Communication Committee Co-Chair David N. Cicilline (D-RI) issued the following statement, saying “This is the cruelest and most immoral thing I’ve seen the Republican Party do to the American people. They just passed a bill that they know will result in the deaths of thousands of working people each year. I don't know how they sleep at night.”

 “All you need to know about this bill is that Republicans tried to exempt themselves from coverage [of the GOP health care proposal]] before they got caught. That’s because they know it’s a raw deal,” says Senator Sheldon Whitehouse.  This legislation sets us on a path to the bad old days when insurance companies could refuse coverage to those with preexisting conditions and deny people health benefits that should be in every plan – like ‎maternity and mental health care, he says.

Whitehouse warns that AHCA’s passage will leave millions of Americans without access to affordable health insurance.  “Rhode Islanders rely on the Affordable Care Act and it’s working here.  If they want to improve it, that’s one thing, but this House bill will hurt Rhode Islanders,

Within hours of the House vote on AHCA, a joint statement was issued by six prestigious national medical organizations (American Academy of Family Physicians, American Academy of Pediatrics, American College of Physicians, American Congress of Obstetricians and Gynecologists, American Psychiatric Association American and the American Osteopathic Association), representing over 560,000 physicians and medical students, denouncing the GOP health bill.  Dozens of other state and national health care organizations, including the American Nurses Association and American Hospital Association (and this number grows daily) also gave a thumb down on the Republican health bill that is considered “unworkable and flawed.” 

Aging advocacy groups came out swinging, too.

AARP, representing 38 million members and considered to be one of the nation’s most powerful aging lobbying groups, plans to hold GOP House lawmakers accounting for their support of AHCA while gearing up to oppose the Republican health care proposal in the Senate.

 In a statement, AARP Executive Vice President Nancy LeaMond reiterated AARP’s opposition to the GOP health bill passed in the U.S. House of Representatives, calling it “flawed” and warning that the legislative proposal “would harm American families who count on access to affordable health care.”

LeaMond says, “the bill will put an Age Tax on us as we age, harming millions of American families with health insurance, forcing many to lose coverage or pay thousands of dollars more for health care.  In addition, the bill now puts at risk the 25 million older adults with pre-existing conditions, such as cancer and diabetes, who would likely find health care unaffordable or unavailable to them.”

According to LeaMond, AARP will continue its opposition of AHCA as it moves for Senate consideration because it “includes an Age Tax on older Americans, eliminates critical protections for those with pre-existing conditions, puts coverage at risk for millions, cuts the life of Medicare, erodes seniors’ ability to live independently, and gives sweetheart deals to big drug and insurance companies while doing nothing to lower the cost of prescriptions.

 LeaMond warns, “We promised to hold members of Congress accountable for their vote on this bill. True to our promise, AARP is now letting its 38 million members know how their elected Representative voted on this health bill in The Bulletin, a print publication that goes to all of our members, as well as through emails, social media, and other communications.”

Medicaid Takes a Major Blow

 “The bill threatens the very heart of the Medicaid program, taking away the guarantee that Medicaid will be there when seniors need it most. By slashing Medicaid funding by over $800 billion, the AHCA will place tremendous strain on state budget, says Kevin Prindiville, Executive Director of Justice in Aging, a nonprofit advocacy group for low-income seniors. “States will be forced to cut services, restrict eligibility, and reduce benefits for seniors, children, people with disabilities, and low-income older adults, he says.

“Congress is forcing families to pay more out-of-pocket when grandparents and other loved ones need nursing home care or home care. Two-thirds of all Medicaid spending for older adults pays for long-term services and supports. The AHCA puts this vital care for seniors in jeopardy,” says Prindiville.  “By passing the ACHA, the House chose to cut taxes for the wealthy and pharmaceutical companies while harming Medicare beneficiaries by increasing Part B premiums and reducing the life of the Medicare Trust Fund, he says.  

Max Richtman, President and CEO of the National Committee to Preserve Social Security and Medicare calls the AHCA vote “appalling” for retirees and views the “raid of Medicare, cuts to Medicaid among the most problematic parts of the AHCA.”

 “Despite the bill’s name, risking the health of our nation’s most vulnerable citizens to give the wealthy an $ 600 billion tax cut is tremendously uncaring --- and does not reflect real American values,” says Richtman.  In modifying the original AHCA bill to give reluctant Republicans political cover, the House leadership made a bad piece of legislation even worse,” he says.

No Protection for Pre-existing Conditions

“Recent amendments to this cruel, ill-advised bill could put coverage for older Americans with pre-existing conditions like cancer and diabetes out of reach. The $8 billion (over 5 years) added to the legislation at the last minute to defray the cost of higher premiums is woefully inadequate.  It’s a thin veil that covers a head of snakes,” notes Richtman

 “Equally inadequate are the meager tax credits that the GOP bill offers older Americans to buy insurance.  A $4,000 annual tax credit doesn’t come to close to covering premiums for seniors ages 60-64, meaning millions of older Americans will lose coverage altogether,” says Richtman.

According to Richtman, AHCA slashes nearly $1 trillion from the Medicaid by converting the social health care program into a block grant program or imposing per capita caps.  “This would make it harder for impoverished seniors to access long term skilled nursing care and community or home care.  Overall, the Congressional Budget Office estimates that 14 million people will be kicked off the Medicaid rolls in the next 10 years if this bill becomes law,” he says.

Richtman observes that the enactment of AHCA would reduce Medicare’s solvency by repealing Obamacare’s 0.9 percent payroll tax on wages above $200,000. This could lead to cuts in Medicare, including privatizing the program --- harming current and future beneficiaries, he says.  

“Under the GOP bill, insurers can charge older enrollees five times more than younger ones.  The Congressional Budget Office predicts that by 2026 this provision will substantially raise premiums for older people by as much as 25 percent,” notes Richtman.

Senate Becomes New AHCA Battle Ground         

After the politically decisive House vote to pass AHCA, President Donald Trump and House GOP lawmakers celebrated their major political victory at the White House Rose Garden claiming that they had fulfilled a promise made 7 years ago to repeal and replace Obamacare.  But this celebration was short lived.  Like House Democratic lawmakers, Democratic and Republican Senators began voicing their skepticism and strong opposition to the House’s passed health bill.   Holding a slim 52-to-48 advantage in the upper chamber, GOP Senate Leadership must craft a bill that can win the support of at least 50 of their caucus members.

Washington insiders are now reporting that the House’s unpopular AHCA is “Dead on Arrival” in the Senate.   Senate Republicans say they will not vote on the House passed bill and the upper chamber is expected to move slowly in crafting its health bill, starting from scratch.   Many GOP Senators opposed AHCA, especially those who want to protect their constituents with pre-existing conditions and others who represent states that have expanded their Medicaid program under Obamacare.

A group of 13 Republican Senators (all men) have begun the process of hammering out their own health bill.    Senate rules do not allow a review of the legislation or the determination of the rules of the debate until the CBO provides its official fiscal impact estimate.   Because of this the health policy debate may not begin until summer.

Hopefully, Senate Majority Leader Mitch McConnell, a Republican from Kentucky, and his partisan working group will reach across the aisle to Democratic Senators to assist in crafting a bipartisan solution. Won’t that be refreshing.

 

 Herb Weiss, LRI’12 is a Pawtucket writer covering aging, health care and medical issues. To purchase Taking Charge: Collected Stories on Aging Boldly, a collection of 79 of his weekly commentaries, go to herbweiss.com.

 

Related Slideshow: Trump’s Win - What Does it Mean for Rhode Island?

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Jennifer Duffy

Cook Report

"We don't really know what a Trump presidency means for the nation, never mind the smallest state.  One of the unintended consequences of last night's results is that Sen. Jack Reed won't be chairman of the Senate Armed Services Committee.  Chalk that up as a loss for RI."

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Pam Gencarella

Head of Ocean State Taxpayers' Association

"Trump’s win means that his signature issue, illegal immigration, could have a big impact on RI, hopefully reversing our course as a sanctuary state and saving the state taxpayer millions of dollars.  While we agree with his 'repeal and replace' Obamacare stance, we have no idea what that means to the RI debacle known as UHIP.  It is not a stretch to believe that federal funding for this kind of system will be off the table so, will RI be stuck with this massively expensive system that still doesn’t work and that is expected to cost another $124 million to fix?  

Trump's belief that there is significant fraud in the Food Stamp program and the policies that may come from that belief could have a negative impact on RI's local economy since there are businesses in certain cities that rely heavily on this program, fraud and all. On the upside, we may be able to ditch the UHIP program if there is significantly less need for processing welfare program requests (ie. Medicaid and food stamps) resulting from fewer illegal immigrants and less fraud.  While we are ambivalent about his touted child care policies, if enacted, it may force our legislators to revisit the ever growing state cost of subsidies in this area and possibly reduce the fraud and abuse in this system." 

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Kay Israel

Professor at Rhode Island College

"With a Republican President and Congress, Rhode Island will probably be excluded from the 'fruits of victory."  

The congressional delegation will be able to vocally make their presence felt, but in the long term it's more symbolic than substantive.  

For Rhode Island it's a matter of holding on and waiting until '18 or '20 and a surge in Democratic influence."

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Jennifer Lawless

Professor at American University

"The RI congressional delegation just became even less powerful than it was. With unified government, Trump doesn’t need to quell Democrats’ concerns or acquiesce because he’s worried about a Democratically-controlled Senate.

His appointments will reflect that. His executive orders will affect that. And the conservative policy agenda he puts forward will affect that."

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Len Lardaro

Professor at University of Rhode Island

"Well there's a few things -- because there's not going to be gridlock, that's a big difference if it had been Hillary and a GOP Congress, in which nothing would got done. We'll at least get a half a billion in infrastructure that's going to pass which will have an impact.

I think you'll see there will be reduced reliance on government nationally -- and that's where we'll stick out like sore thumb. We've relied way too much on government -- and our government is highly inefficient and ineffective.  Maybe, just maybe, in this who cycle of things we might be forced to be small and more efficient for once.

A couple of other things -- interest rates jumped. The one to follow is the ten year government bond rate -- which is tied to mortgages. It went from 1.7% to 2.05% in one day. The point is -- if the ten year stays high, mortgage rates will start going higher -- and in the short time people will run to re-finance. 

That's the short term impact -- but then if rates stay hight, that will make mortgages more out of reach. And we just passed a bond issue to limit open space -- housing has limited upside here.
The next thing -- the Fed Reserve will go ahead with tightening next month. A strong dollar will hurt manufacturing. When the dollar is strong our exports become more expensive overseas. 

Our goods production sector -- manufacturing and construction -- in the near term will do a little better, but as time goes on will be more limited. But something you won't hear, is there are lags in fiscal policy, of six months to year. So we won't really see the effects until the third our fourth quarter of 2017, going into 2018."
 

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Mike Stenhouse

RI Center for Freedon and Prosperity

"As the unbelievable turned into reality this morning, it struck me that the presidential election was not really all about Donald Trump and Hillary Clinton. It was about a fed-up people, revolting against a corrupt system - the "beast" - that relentlessly favors insiders. Hillary personified the beast, while Donald personified the slayer.

Sadly, based on election results in our state, Rhode Island's version of the beast lives on. I fear our political class has not learned the lessons from the Bernie Sanders and Donald Trump movements - and will continue with their government-centric, anti-family, anti-business status quo."

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Kristina Contreras Fox

VP of Young Democrats of America

"A Trump Presidency means the validation of the ugliest part of America. In RI, as with the rest of the country, the hammer of his hatred will fall hardest on minority communities. Being a blue state doesn't make us immune from this danger.

Trump won over 35% (39.5) of the vote here! We need to look in the mirror, and not lie about what the reflection shows us. No more hiding underneath a blue blanket. I expect those who claim Democratic values to be true to those values. The gulf between words and actions have turned into fertile ground for Trump's message to grow here in RI. If you call yourself a Democrat, if you claim to stand in opposition to Trump, now is the time to prove it. Show up and fight back."
 

 
 

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