Poor, Disabled, Diabetic, Young and Old Oppose US Senate Health Care Bill
Many organizations are speaking up to oppose the proposed U.S House and Senate Health Care Bills. People with pre-existing conditions will pay more, the rich will pay less. The poor, especially the elderly poor lose coverage as do all Americans, even those with employer health plans who no longer are guaranteed essential services for pregnancy, birth control, emergency room visits and mental health services to name a few.
See who the winner and losers are under the proposed bill.
We have included several organization opposition statements below. You too can voice you opinions and help protect your family.
The following is a statement from Katy Neas, Easterseals Executive Vice President of Public Affairs, reacting to the Senate Republican release of the Better Care Reconciliation Act of 2017:
The Senate’s Better Care Reconciliation Act released today by Majority Leader Mitch McConnell jeopardizes the health and well-being of millions of children and adults with disabilities. The Medicaid system that provides essential home and community-based care is already underfunded, has resulted in cuts to services and has increased the long wait lists the individuals and families we serve across the country endure. The Senate bill will accelerate this problem by instituting restrictive caps on federal Medicaid funding—using formulas that result in cuts that are worse than those set in the U.S. House-passed bill formula.
Capping and cutting Medicaid will hurt—not improve—the ability of a child with cerebral palsy to access physical therapy, for a student with autism to receive behavioral health services, for a young adult with a spinal cord injury to receive personal assistance services to get to his job, and for a vulnerable senior to access home health services.
Easterseals urges the U.S. Senate to oppose the Better Care Reconciliation Act based on its cuts and caps to Medicaid services for children and adults with disabilities.
The American College of Emergency Physicians
The American College of Emergency Physicians (ACEP) today issued a statement deeply critical of the draft health care legislation introduced yesterday in the Senate, known as the Better Care Reconciliation Act, or BCRA. ACEP’s president, Dr. Rebecca Parker, said:
“Senators should vote ‘no’ on BCRA as it stands today. After holding out hope that the Senate would develop a bill more in line with our priorities, we are extremely disappointed that the Senate’s health care legislation is no better and actually worse than what was introduced in the House of Representatives, the American Health Care Act. The draft that was introduced yesterday makes sweeping changes to the health care system that directly contradict ACEP’s principles and endanger patient safety and patients’ lives. It is a step backwards from improving the health of the nation.
Of immediate concern is the gutting of Medicaid coverage for millions of Americans who will likely be uninsured or underinsured as a result. The inevitable consequence of people losing their insurance is increases in patient loads and crowding at emergency departments, which are already seeing record numbers of patients. Similarly, when patients have insurance with astronomical deductibles, they delay regular care until a problem becomes so acute they end up in the emergency department. This new legislation will create burdens on ERs that are unsustainable and dangerous.
In addition, the loss of guaranteed coverage for emergency care – which was one of the essential health benefits of the Affordable Care Act – is basically a gift to insurers, who historically have always chosen to deny coverage when given the option. Access to emergency medical care is critical to all Americans, as is insurance coverage for that care. In a recent poll, Americans overwhelmingly — 95 percent— wanted health insurance companies to cover emergency medical carei.
We also have grave concerns that this bill does nothing to address the epidemic of opioid and drug dependence in the country, which led to a 99 percent increase in emergency department visits between 2005 and 2014.ii No members of the medical profession see the scourge of opioid addiction more than emergency physicians. The amount of money set aside by BCRA for treatment of the disease of addiction is no better than pocket change.
“Kaiser Permanente believes progress in health care should be judged on access, affordability and outcomes. Changes to our nation’s health care laws, therefore, should increase access to high-quality, affordable care and coverage for as many people as possible.
“We cannot support the current Senate draft bill, as it is clear that the changes to Medicaid and the reductions in subsidies for low-income people enrolled in the Exchanges will lead to reduced coverage in our country. We are concerned that the repeal of the individual mandate without alternative incentives for enrollment likely will lead to fewer people enrolled and higher premiums, and that changes to the state waiver process could also result in the erosion of coverage of needed medical services. We acknowledge that the draft attempts to address the need for market stabilization measures, but these provisions are outweighed by the broader impact of the legislation.
“The draft bill does not expand coverage; it does not do enough to protect people in need of care, nor does it provide enough assistance to those who need help in paying for health care and coverage. We will continue working to share our perspective with the Senate on how to address these concerns to improve health and health care in this country.”
The American Diabetes Association
The American Diabetes Association has grave concerns about the impact the draft Senate health care bill will have on people with diabetes. Individuals with diabetes need access to continuous health care to effectively manage their disease and to prevent dangerous and costly complications. The proposed legislation could significantly limit access to care and yield increased costs for people with diabetes, and particularly for older Americans, who are at greater risk for diabetes. The bill also does not guarantee comprehensive coverage.
The Association is troubled by the proposed changes to Medicaid and the negative impact of these changes on low-income Americans, who are disproportionately affected by diabetes. In states that expanded their Medicaid programs, more individuals are being screened for diabetes than non-expansion states. Cuts to Medicaid would leave the most vulnerable individuals with or at risk for diabetes without the health coverage they need to be diagnosed and treated for the disease as early as possible.
As currently drafted, the Association cannot support this legislation. It falls far short of the minimum standards for replacing the important safeguards and coverage provided by the Patient Protection and Affordable Care Act (ACA), which the Association has outlined. We urge all Senators to vote no on this bill and to work toward meaningful legislation that will protect access to affordable and adequate health care coverage for people with diabetes.
The Better Care Reconciliation Act (BCRA) now under consideration in the Senate would drastically alter the Medicaid program. The proposed Senate bill would change the way the federal government currently funds Medicaid by limiting federal funding and shifting cost over time to both states and Medicaid enrollees. BCRA would subject older adults, adults with disabilities, and children to mandatory per enrollee caps beginning in 2020. State Medicaid programs would have the option to choose between block grants and per enrollee caps for non-elderly non-disabled non-expansion adults.
The Senate bill would start out using the medical care component of the Consumer Price Index (M-CPI)—a measure of the average out-of-pocket cost of medical care services used by an average consumer—as the growth rate for per enrollee caps. However, beginning in 2025, it would slash the growth rate to the Consumer Price Index for all urban consumers (CPI-U)—a measure of general inflation that examines out-of-pocket household spending on goods and services used for everyday living. CPI-U does not tie closely to medical costs and will not reflect population growth or the impact of aging. To be clear, none of the proposed growth factors—M-CPI, M-CPI+1, and CPI-U— keep pace with the growth in Medicaid spending.
Although studies have examined the impact of Medicaid spending cuts in the House-passed healthcare bill over a 10 year period (e.g. [CBO] [CMS] [Urban Institute]) we know of none that examine the impacts over a longer time horizon. To fill this gap, the AARP Public Policy Institute has developed a model that looks out an additional decade to capture impacts on Medicaid spending between 2027 and 2036.
By dramatically reducing the per capita cap growth factor beginning in 2025, we project that the Senate bill would cut between $2.0 and $3.8 trillion from total (federal and state) Medicaid spending over the 20-year period between 2017 and 2036 for the four non-expansion Medicaid enrollment groups: older adults, adults with disabilities, children, and non-expansion adults (children with disabilities are excluded because BCRA does not subject them to capped funding). A cut of this magnitude threatens the viability of the program in unprecedented ways and will increase the number of people who no longer have access to essential healthcare services and critical supports. The projections do not include the proposed cuts to the adult expansion population, which would also be considerable.
Ms. Jensen is a leading advocate for families and children and was the founder and president of ACES, The Association for Children for Enforcement of Support.
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