WASHINGTON — As House Republicans released their plan to replace Obamacare today, four Republican senators protested inadequate protections for Medicaid expansion programs and vowed to not support a bill that didn’t give beneficiaries a stable transition to a rock-solid foundation.
Sens. Cory Gardner (R-Colo.), Rob Portman (R-Ohio), Shelley Moore Capito (R-W.Va.), and Lisa Murkowski (R-Alaska) sent a letter to Senate Majority Leader Mitch McConnell (R-Ky.) arguing that while “structural reforms” to Medicaid are needed, the draft House GOP plan that began circulating last month “does not provide stability and certainty for individuals and families in Medicaid expansion programs or the necessary flexibility for states.”
The House Republicans’ plan includes a per capita cap for Medicaid spending, with states responsible for 100 percent of the amount exceeding the federal allotment. As healthcare costs increase, including due to outbreaks, public health crises or an aging population, states would still absorb the extra costs.
In the year 2020, under the bill, the federal government would pay no more funds for Medicaid expansion.
Amid criticism of the cuts, House Speaker Paul Ryan (R-Wis.) tweeted, “Our plan will modernize Medicaid to protect the most vulnerable.”
House Majority Leader Kevin McCarthy (R-Calif.) insisted in a statement that the GOP plan “will put Medicaid on a fiscally sustainable path while protecting individuals who gained coverage through the Medicaid expansion.”
The four dissenting GOP senators wrote to McConnell that they are “concerned that any poorly implemented or poorly timed change in the current funding structure in Medicaid could result in a reduction in access to life-saving health care services.”
“The Medicaid population includes a wide range of beneficiaries, many of which cycle on and off Medicaid due to frequent changes in income, family situations, and living environments,” they wrote. “The Department of Health and Human Services reports that nearly one-third of individuals covered under the Medicaid expansion have a mental health or substance use disorder. As the largest payer of mental health and substance use services in the United States, it is critical that any health care replacement provide states with a stable transition period and the opportunity to gradually phase-in their populations to any new Medicaid financing structure.”
Portman, Capito, Murkowski and Gardner said Medicaid reform “should not come at the cost of disruption in access to health care for our country’s most vulnerable and sickest individuals.”
“Any changes made to how Medicaid is financed through the state and federal governments should be coupled with significant new flexibility so they can efficiently and effectively manage their Medicaid programs to best meet their own needs,” the senators continued. “…We will not support a plan that does not include stability for Medicaid expansion populations or flexibility for states.”
Democrats weren’t keen on the prospect of eliminating Medicaid expansion, either. Some crossover support will be needed to clear a 60-vote procedural threshold.
“GOP health plan’s proposal on Medicaid is a disgrace to our nation and I will fight it with everything I have,” tweeted Sen. Bob Casey (D-Pa.). “This would mean cuts for seniors, those with disabilities and those with low incomes. Hell no, I won’t go along with it.”
“You can’t wax poetically about how you care for seniors, those with disabilities & those who struggle financially if you support this scheme,” Casey added, accusing Republicans of “selling snake oil as a viable replacement.”
McCarthy stressed that the Obamacare replacement gets rid of the individual mandate and creates “universal access to private insurance” while protecting patients with pre-existing conditions. The bill ends subsidies to buy healthcare coverage, replacing these with tax credits for between $2,000 and $4,000 per year. Taxes created under Obamacare, including the medical device tax that drew bipartisan opposition, would be killed.
“The American Health Care Act is a plan to drive down costs, encourage competition, and give every American access to quality, affordable health insurance,” Ryan said. “It protects young adults, patients with pre-existing conditions, and provides a stable transition so that no one has the rug pulled out from under them.”
Ryan promised that the bill “will proceed through a transparent process of regular order in full view of the public.”
Senate Minority Leader Chuck Schumer (D-N.Y.) quickly dubbed the new bill “Trumpcare,” saying it’s not an Obamacare replacement because “it forces millions of Americans to pay more for less care.”
“This plan would cut and cap Medicaid, defund Planned Parenthood, and force Americans, particularly older Americans, to pay more out of pocket for their medical care all so insurance companies can pad their bottom line,” Schumer said. “It cuts taxes on the rich to make middle class families pay more. To make matters worse, this sham of a replacement would rip treatment away from hundreds of thousands of Americans dealing with opioid addiction, breaking the president’s word that he would expand treatment, not cut it.”