Doctors, hospitals and insurers oppose Republican health plan
By Juliet Eilperin and Mike DeBonis
March 8 at 9:58 PM - The Washington Post
Major associations representing physicians, hospitals, insurers and seniors
all leveled sharp attacks against the House GOPfs plan to rewrite the Affordable
Care Act on Wednesday, as some Republicans publicly questioned whether the
measure can clear the House of Representatives.
While industry groups warned that the proposal could leave vulnerable
Americans with fewer protections than they now have, GOP leaders pressed ahead,
bringing legislation before two key committees that are expected to approve the
bills by weekfs end. They were also working in concert with the White House to
win over conservatives, who have complained that the proposal preserves too much
of the current law.
The flurry of activity — including an evening meeting between President Trump
and leaders from five skeptical conservative groups — created new uncertainty
about the viability of Republicansf signature promise to repeal and replace
Obamacare.
The dayfs events also showed the uneasy predicament facing House Speaker Paul
D. Ryan (R-Wis.), the proposalfs chief booster, who described the plan Wednesday
as a gconservative wish listh that would deliver on years of GOP campaign
promises to change the nationfs health-care system.
gRight now I feel confident saying there arenft 218 votes for this,h said
Rep. Scott Perry (R-Pa.), a member of the conservative Freedom Caucus, who was
referring to the number of votes needed to pass the measure out of the House.
Perry opposes the proposal.
The barrage of criticism shows how fraught the terrain of health-care policy
is. It also reflects a backlash prompted at least partly by the breakneck speed
with which House Republicans are trying to push through their proposal — with
little upfront effort to work with interest groups or political factions.
gWhat wefre seeing now is that the political prospects for repealing the
Affordable Care Act are as daunting as the effort to pass national health
reform,h Larry Jacobs, a political science professor at the University of
Minnesotafs Hubert H. Humphrey School of Public Affairs, said in an
interview.
House Republican leaders have given little indication that they will make
anything but marginal changes to their plan, which would eliminate the
requirements that all Americans obtain coverage or pay a tax penalty and that
businesses with at least 50 employees provide insurance. The American Health
Care Act would replace income-based subsidies with refundable tax credits based
on age and income, charge individuals a 30 percent surcharge if they buy a
plan after allowing their coverage to lapse and phase out the lawfs more
generous Medicaid funding over time.
While conservatives complained that these changes donft go far enough, they
have sparked criticism not just from Democrats but from moderate Republicans,
AARP, the American Medical Association and the American Hospital Association.
gWe cannot support the AHCA as drafted because of the expected decline in
health insurance coverage and the potential harm it would cause to vulnerable
patient populations,h James L. Madara, chief executive of the American Medical
Association and a doctor, wrote in a letter to committee leaders overseeing work
on the bill.
Richard Pollack, CEO of the American Hospital Association, voiced similar
fears, saying efforts to grestructure the Medicaid programh by shifting it from
an entitlement program to one based on a per capita allocation gwill have the
effect of making significant reductions in a program that provides services for
our most vulnerable populations and already pays providers significantly less
than the cost of providing care.h
Americafs Health Insurance Plans, the insurance industryfs largest trade
association, sent a letter Wednesday saying that while it appreciated several of
the proposed changes, the changes to Medicaid gcould result in unnecessary
disruptions in the coverage and care beneficiaries depend on.h
House Energy and Commerce Committee Chairman Greg Walden (R-Ore.) told
reporters Wednesday that critics were exaggerating the proposalfs potential
repercussions.
gItfs tough to do entitlement reform, itfs tough to make these changes, but I
think at the end of day, seniors are going to be fine,h Walden said. gIf youfre
on Medicaid today, youfll be on Medicaid tomorrow. States can intercede here and
help out. So therefs more to this story.h
Walden said it was gsort of shockingh that hospital groups were strongly
opposing the plan, because the GOP legislation restores the ACAfs cuts to
gdisproportionate shareh payments to hospitals that serve large numbers of
uninsured patients.
gTherefs a pretty big medical-industrial complex in America,h he added. gAnd
when you touch it, Ifve discovered, it touches back.h
House Republicansf determination to deliver on their promise to undo the ACA
— Ryan said Wednesday that it is gthe covenant we made with the American people
when we ran on a repeal-and-replace plan in 2016h — has spurred a legislative
drive that is happening at warp speed.
A cadre of lawmakers and staffers worked behind closed doors for several
weeks to draft the pair of bills, which were designed to move through the annual
budget process in order to clear the Senate with a simple majority vote.
But that process, which did not involve an extended period of negotiation
with interest groups or consultation with Democrats, has produced a furious
backlash.
Some insurers, including Molina Healthcare and the Alliance of Community
Health Plans, said they did not get to offer any input into the House
proposal.
gIt doesnft seem like the industry got any heads up or was involved. We
definitely were not,h Sunny Yu, spokeswoman for Molina Healthcare, which has
about a million members in the Affordable Care Act exchanges, said in an
email.
Democrats threw up procedural obstacles Wednesday in the committee meetings
and on the House floor, complaining that it was irresponsible to consider the
bills before the Congressional Budget Office offered an analysis that showed the
legislationfs impact on the budget and Americansf overall health care
coverage.
gWe need to know, what this is going to cost?h asked Rep. Anna G. Eshoo
(D-Calif.), a member of the Energy and Commerce Committee. gWe need to know,
what kind of health insurance is going to be feasible?h
Both House Republicans and White House budget director Mick Mulvaney have
predicted that they will have a CBO gscoreh ready by early next week, before the
bills are combined and brought before the House Budget Committee. GOP staffers
noted that other health-care bills, including the 21st Century Cures Act and the
2015 reauthorization bill for Medicare and the Childrenfs Health Insurance
Program, began their journeys through congressional committees without a CBO
score.
Democrats on the Energy and Commerce Committee moved to delay the billfs
consideration for 30 days, while those on Ways and Means moved to delay it for
one week to allow for further hearings and to examine the CBO report. Both
motions were voted down on a straight party-line vote, and the panels continued
working into the evening.
Still, the most imminent threat GOP leaders must contend with comes from the
far right. The speaker can lose only 21 Republican votes if the American Health
Care Act is to pass, and opponents are promising to use that leverage to force
changes to the bill.
Rep. Thomas Garrett (R-Va.), a freshman member of the conservative House
Freedom Caucus, said he was confident that his camp could help reshape the
legislation. While Trump had endorsed it already, Garrett said, he would
probably be willing to accept something else if it were changed in a way
conservatives could support.
gThis is a guy who said he wasnft sure that NATO, in its classic role, is
necessary — and then two months later we saw countries like Germany vow to
increase their defense spending to 2 percent of GDP,h said Garrett. gWhyfd
they do that? Because Donald Trump wasnft going to accept the status quo. They
made a counteroffer. Right now, therefs an offer, and hefs saying he likes to
get people to make counteroffers.h
Vice President Pence met with two House Freedom Caucus leaders Tuesday, and
that same day Mulvaney — a former caucus member — spent more than an hour at a
meeting of the group. Its members have been invited to visit the White House
next Tuesday.
Wednesday night, Trump met with leaders from Americans for Prosperity, the
Club for Growth, FreedomWorks, the Heritage Foundation and its political arm,
Heritage Action, and the Tea Party Patriots.
But the hard reality for Republicans is that any changes made to appease
House conservatives could threaten the billfs support among moderates.
gMy fear is that the bill will go backwards,h said Rep. Tom MacArthur
(R-N.J.), a co-chairman of the centrist Tuesday Group who has gotten White House
attention of his own: He met Tuesday with Health and Human Services Secretary
Tom Price. gIf the bill starts going in the reverse direction in order to
satisfy certain members of my party, then Ifm going to have a problem. I think
the federal government has a role to play here, and Ifm not looking to just see
the federal government undermine the health-care needs of the American
people.h
Sen. Susan Collins of Maine, a pivotal Republican moderate, said in an interview Wednesday with Yahoo Newsf Katie Couric that the
current House measure would gnot be well received in the Senateh and stood no
chance of passing as is. gI want us to slow down to take more time to be sure we
get this right.h
David Weigel, Carolyn Johnson, Elise Viebeck and Amy Goldstein contributed to
this report.