The bill, called the Better Care Reconciliation Act, is the Senate’s response to the American Health Care Act that the House passed in May in an attempt to repeal and replace the Affordable Care Act.
Insiders had once said the effort to repeal Obamacare was dead, but a group of Republicans worked behind closed doors over the past several weeks to come up with a new bill. They released the details Thursday.
The bill would roll back patient protections, reduce Medicaid funding, and cut certain taxes on insurers, medical companies and higher-earning households.
“The bill Republicans announced today is even worse than expected and by far the most harmful piece of legislation I have seen in my lifetime,” Sen. Bernie Sanders, I-Vt., said in a statement. “This bill has nothing to do with health care. It has everything to do with an enormous transfer of wealth from working people to the richest Americans.”
“Republicans want to throw millions of Americans off of health insurance – including thousands of Vermonters – slash Medicaid, defund Planned Parenthood and substantially increase premiums on older Americans,” Sanders said.
“Meanwhile, their bill would provide over $200 billion in tax breaks to the top 2 percent and hundreds of billions more to the big drug and insurance companies that are ripping off the American people.”
“This bill would affect real people, real families, in Vermont and across the country,” Leahy said. “This isn’t a political campaign. This is about life, and death, and every family’s access to health care.”
“A true health care bill does not cut millions of Americans off health insurance,” he said. “A true health care bill does not allow insurance companies to charge people more for less coverage. I will do all I can to prevent enactment of this disastrous plan, or anything that comes close to it.”
Gov. Phil Scott, a Republican, said his staff is still working to review the Senate’s bill. In a statement, Scott said he had serious concerns about “the harmful impact the legislation would have on Vermonters.” Scott said the bill would undermine Vermont’s success “in providing near universal coverage.”
“The ACA, while not perfect, measurably improved the health and well-being of Vermonters by expanding coverage, reducing the state’s uninsured rates, enabling Vermont to form health care provider networks that participate in shared savings programs, and fostering initiatives to reduce utilization and cost through its health care delivery reform provisions,” Scott said.
The bill would allow insurance companies to refuse to cover pre-existing health conditions, like cancer. That effectively repeals one of the biggest consumer protections for insurance customers that Vermont had already had for years but the Affordable Care Act codified into federal law.
The Senate bill would repeal the federal mandate that individuals must buy insurance or pay a penalty, repeal the mandate that many employers must offer insurance to their workers, and lower the amount of help people get paying for insurance through exchanges like Vermont Health Connect.
Currently, Americans are forced to buy insurance or pay a penalty, a policy intended to encourage healthy people to buy insurance so that premiums can stay lower. The federal government helps low-and middle-income people pay for that insurance, and Vermont offers additional help to people using Vermont Health Connect.
The House bill would lower the subsidy and remove the requirement for individuals to carry insurance. The Senate bill would simply eliminate the individual mandate but make no other policy changes to encourage healthy people to buy insurance.
A Republican health care expert in Washington, D.C., calls that “a recipe for a death spiral” in insurance markets.
Additionally, the bill would place a per-capita maximum on how much funding states can get for Medicaid, a state-federal hybrid program for low-income people and people with disabilities. That maximum would slash funding to Medicaid by more than $880 billion over 10 years, starting in 2021.
For one year, Medicaid patients would be barred from using their insurance at Planned Parenthood, which is already ineligible to get federal funding for abortions. Young adults could continue to stay on their parents’ insurance until age 26. Americans would be encouraged to put more money into Health Savings Accounts.
At the same time, the Senate bill would cut certain taxes on health insurance companies, pharmaceutical companies, medical device manufacturers, tanning salons, and families earning more than $250,000.
“These enormous Medicaid cuts would have especially devastating effects in Vermont,” Leahy said. “One in four adults in Vermont is covered by Medicaid. Almost half of Vermont’s children rely on Medicaid or CHIP for basic health care. Two in three nursing home residents receive Medicaid.”
“These are the most vulnerable Vermonters,” he said. “These are nursing home patients and their families, pregnant women, children, people with disabilities, and their families — Vermonters working multiple jobs, but who still cannot afford health insurance.”
A per-capita cap on Medicaid spending would have a disproportionate impact on elderly people and people with disabilities. In 2015, Vermont Medicaid spent about $48,000 taking care of each elderly person who needed long-term care. Vermont Medicaid spent $24,000 per year taking care of each child with disabilities, $13,000 per person to take care of adults with disabilities, and about $12,000 per year taking care of adults who needed both Medicare and Medicaid coverage.
In contrast, adults and children who use Medicaid based on incomes are inexpensive for the state to insure. In 2015, Vermont Medicaid spent $5,000 per year for each adult using the program based on their income, and $4,000 for each child using the program because their parents have low incomes. Those cost trends were similar back in 2012, before the state expanded Medicaid enrollment under the Affordable Care Act.
Jeff Tieman, the CEO of the Vermont Association of Hospitals and Health Systems, said he felt “really devastated” by the bill and the potential harm it could cause to Vermonters.
Tieman, who helped write the Affordable Care Act while working for the Catholic Health Association in Washington, D.C., said the legislation is “an enabling step for tax cuts that would help the rich and destabilize our health care system and the gains we’ve made.”
“That to me is not a fair tradeoff,” Tieman said. “I think it’s ill-conceived, ill-advised, and the wrong direction.”
He estimated “conservatively” that Vermont hospitals would lose $25 million a year in Medicaid reimbursements. One hospital CEO estimated that 60,000 Vermonters would lose their health insurance under a previous version of the bill.
Tieman said more people could die under the plan.
“When people don’t have the health care they need, or they’re forced to make decisions based on finances instead of medicine, then, yeah, there’s the potential for people to die or become more ill,” he said.
Jill Olson, the executive director of the VNAs of Vermont, said about 30 percent of the patients they see use Medicaid to get their home health care. She said the bill in Congress would be “devastating” to the Medicaid patients served by home health agencies.
“The cuts under consideration would shift a greater burden onto patients and their families and increase otherwise preventable hospital and nursing home admissions,” Olson said.
The future of the Senate bill is currently unclear because five Republican senators have announced they would not support the bill, according to The Washington Post.
