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Amid GOP silence, Pa. health care groups worry over Senate bill

Jason Addy
York Dispatch

As Republicans in the U.S. Senate work behind closed doors to replace the Affordable Care Act, several health care advocacy groups in Pennsylvania are speaking out about what they fear will be in the bill when it’s finally released.

Republican Senate leaders are pushing mightily to write and pass a bill to replace former President Barack Obama’s signature health care law by the end of June. 

After “many productive discussions” with GOP senators, Senate Republicans “will soon have a chance to turn the page of this failed law,” Senate Majority Leader Mitch McConnell of Kentucky said Tuesday.

Senate Majority Leader Mitch McConnell of Ky., right, accompanied by Sen. John Barrasso, R-Wyo., meets with reporters on Capitol Hill in Washington, Tuesday, May 23, 2017, following after a Republican policy luncheon. (AP Photo/Jacquelyn Martin)

But with less than two weeks to vote on the measure before the Senate’s summer recess, GOP lawmakers have yet to tell their Democratic colleagues — and many Republican senators — what will be in the bill.

Although Senate leaders said they expect to have a draft of the bill by Thursday, Republican Utah Sen. Mike Lee said Tuesday he has not seen the legislation, despite being a member of the select group of senators said to be writing the bill.

Bad starting point: For organizations that might have to overhaul their plans and strategies to comply with a new health care bill, details also are scarce.

Jeff Bechtel, senior vice president of health economics and policy for the Hospital and Healthsystem Association of Pennsylvania, said he believes the Senate’s plan will mostly resemble the American Health Care Act passed by the House, but “it looks like the Senate bill might be less favorable than the House bill.”

More:Casey: American Health Care Act 'morally bankrupt'

While the Senate’s proposal might allow for a longer phase-in period for funding cuts to Medicaid expansion, Bechtel said his association's staff fears the Senate could try to shift more of the payment responsibilities to state governments by further lowering the per-capita caps on what the federal government will cover.

If the federal government eliminates its funding for states that expanded Medicaid access under "Obamacare," Pennsylvania would be faced with the “very difficult decision” to come up with $2.5 billion to $3 billion annually for the expanded coverage or slash coverage, Bechtel said. 

House Republicans' plan to replace the individual subsidies provided under the Affordable Care Act with less-flexible tax credits is “not sufficient” for individuals with very low incomes to provide their own coverage, Bechtel said.

More:In York, Casey vows fight in Senate to save "Obamacare"

Instead of trying to overhaul the nation’s health care system, lawmakers should be focusing on maintaining coverage and taking measures to stabilize health insurance markets around the country, Bechtel said. 

“We are committed to preserving affordable and reliable access to health care. We support insurance coverage for Pennsylvanians,” Bechtel said. “Simply put, we do not believe that the American Health Care Act is an acceptable starting point for reforming the system.”

Fund Medicaid: Though Pennsylvania Health Care Association members had “open and candid” conversations with Pennsylvania Sens. Bob Casey and Pat Toomey during a recent trip to the nation’s capital, the association still only knows what the general public knows about the bill — which isn’t much, said W. Russell McDaid, president and CEO of the association.

PHCA is a statewide advocacy organization working on behalf of more than 500 health care providers, nursing homes, pharmacies and other groups to ensure quality care for more than 50,000 vulnerable elderly and disabled residents.

More:Scrapping ‘essential benefits’ might be biggest health care change

The uncertainty surrounding the Senate’s proposal is just a distraction for the association's providers who work every day to care for their patients, but for management staff, “it’s very difficult to plan for anything at this point,” McDaid said.

McDaid said his organization is “extremely concerned” about both the Senate’s upcoming proposal and the House GOP-approved American Health Care Act “because neither is a good option.” 

Lawmakers should be digging deep to keep the country’s commitment to its senior citizens by protecting access to Medicaid and Medicare services, McDaid said.

McDaid said the association has “significant concerns” about any plan that reduces Medicaid spending below current projected rates, as Pennsylvania’s elderly population is one of the largest in the country and continues to grow. 

“More people aren’t going to need less care,” McDaid said.

At current funding levels, the average Medicaid reimbursement is already $25 short of costs, McDaid said, while any bill that promises savings over the next five to 10 years will only exacerbate that funding gap. 

“The cost realities of those programs (Medicaid and Medicare) aren’t pretty for policy makers, and they’re even less pretty for politicians (facing re-election), but they’re reality,” McDaid said.

‘No value to society’: Lynn Keltz, executive director of the Pennsylvania Mental Health Consumers’ Association, was straightforward about her organization’s opposition to lawmakers’ attempts to repeal and replace the Affordable Care Act.

Any health care plan that takes away expanded access to Medicaid and health insurance coverage “has no value to our society,” Keltz said.

The organization's staff of health insurance navigators has worked through the enrollment process with many of the more than 750,000 Pennsylvanians who have gained coverage since "Obamacare" was rolled out. 

Without federal funding for the expanded coverage, people will lose access to mental health care and drug-and-alcohol treatment programs that can be vital to curbing the ongoing opioid epidemic, Keltz said.

Keltz said groups such as hers could help lawmakers draft a better health care bill with their knowledge and “lived experience” in navigating the health care system with consumers.

“It seems that the leaders right now in the Senate and the House do not bring that lived experience to the table — that they’re looking more at political aims than the needs of constituents,” Keltz said.

“It’s fine to say you want to help people, but you have to put money behind that. Fund the care you want,” Keltz added.

Richard Burrill, a Put People First PA activist from Springettsbury Township, said it is “totally reprehensible” for Senate leaders to try to put a “top-secret” health care bill up for a vote without any real debate.

Burrill, who supports a single-payer health care system, said it was “wrongheaded” of lawmakers to try to improve the health care system by doing away with a statute that expanded coverage to hundreds of thousands across the state,

“How are people in rural areas in Pennsylvania and those who don’t have the money, can’t afford health insurance, can’t afford to go to a doctor — how are they to get health care?” Burrill said.