The new bill passed the U.S. House on Thursday. It now moves to the U.S. Senate, where the bill’s future is unclear.
The legislation is largely the same as the original American Health Care Act, which economists said would lead to 24 million fewer people across the country being insured.
This bill, like the last one, would also cut funding to Medicaid starting in 2020, give people help paying for insurance based on their age but not their income, and defund Planned Parenthood for at least one year.
Additions in the latest version would allow states to obtain federal waivers from having to implement guaranteed issue — the consumer protection that forces insurance companies across the country to cover people with pre-existing conditions, like cancer.
States could also request waivers from the federal government so insurance companies would not have to provide coverage for prescription drugs, substance abuse treatment, mental health care and maternity care, among other things.
Vermont has been requiring insurance companies to cover pre-existing conditions since 20 years before the Affordable Care Act, and health care leaders said in interviews that they doubt state officials would request any other waivers to roll back coverage.
But the state also relied on the Affordable Care Act, known as Obamacare, to expand Medicaid coverage to give insurance to tens of thousands of Vermonters and cut the state’s uninsured rate in half. Vermont now has one of the lowest uninsured rates in the country.
“One could argue that the only people who really benefit under this are really wealthy people, and some companies who paid taxes that were part of the Affordable Care Act, like medical device manufacturers,” said Jeff Tieman, the chief executive officer of the Vermont Association of Hospitals and Health Systems.
“But as far as everyday people and everyday Vermonters, I cannot think of anyone who would benefit from this,” Tieman said. He added: “The entire health field is aligned against this bill,” from doctors and home health workers to hospitals and insurance companies.
“The state’s analysis is that this could be really, really tough for the state of Vermont,” Gobeille said. He added that once laws are passed they go through a rulemaking process, and he is worried the Trump administration’s rules could make things even worse.
Tom Huebner, the chief executive officer of Rutland Regional Medical Center, is the New England representative for the American Hospital Association, which opposed the bill in March and continues to oppose the current bill.
Huebner said the March bill likely would have thrown 60,000 Vermonters off their health insurance. He said the number who would lose coverage under the new bill could stay the same in Vermont, which will likely continue to cover pre-existing conditions, but be higher than 24 million at the national level.
“The House bill is a bad bill,” Huebner said. “It has not been scored yet by the Congressional Budget Office, so we don’t know exactly how many Americans are projected to lose their coverage. People I’ve talked to think it’s going to go up from the earlier version.”
“The Senate will pass their version of the bill,” he said. “Then we’ll see what happens next and whether they can come together at some point maybe in the fall. The House version of the bill in my point of view is a bad bill and will definitely reduce coverage for Vermonters.”
Don George is the chief executive officer of Blue Cross Blue Shield of Vermont, which covers 70 percent of Vermonters with commercial insurance and 90 percent of people who use Vermont Health Connect.
He called coverage for pre-existing conditions a consumer protection that Vermont law had for 20 years prior to the Affordable Care Act. He said the proposal in Congress “just seems like they’re pulling apart the consumer protections that were made uniform across the entire country.”
“I think our interest is in this not going forward,” George said. “We have interest in the Affordable Care Act holding together, the consumer protections being uniform not only in Vermont but across the country.”
The Vermont Medical Society, which represents doctors of all specialties in the state, issued a statement Friday opposing the American Health Care Act “based on the belief that affordable, high-quality health care should be available to all Vermonters and Americans.”
“The members of VMS have dedicated their careers to addressing the health care needs of Vermonters and improving their access to high-quality care,” the statement said. “The Vermont Medical Society cannot therefore support AHCA as passed by the U.S. House.”
“The Society calls upon the members of the United States Senate to help ensure the continued rights of all Vermonters and all Americans under the ACA to access affordable and high-quality care by either defeating or drastically altering AHCA,” the statement said.
The University of Vermont Health Network said in a statement: “The measure passed by the House last week could have a significant impact on the health care system in Vermont – a system that has been rated the best in the nation by the 2017 Commonwealth Fund scorecard on state health system performance.”
“Although Vermont would be unlikely to adopt some of the changes the bill would allow – like reducing the level of benefits insurance policies could cover in order to lower premiums – other aspects would definitely impact Vermont residents and employers,” the statement said.
“We will be looking to the Senate to restart and reset the discussion,” the statement said.
