Reps. Kevin Brady and Greg Walden discuss the American Health Care Act.
Since Republican's released their promised Affordable Care Act replacement on Monday, opponents have lined up to stand against the proposed law. The AARP has blasted the bill, dubbed the American Health Care Act, for increasing the cost burden for retirees. Congressional Conservatives are bucking their party brass over what they see as another entitlement program being pitched, and two major hospital associations are saying the proposal would hurt their provider members.
In a letter sent to members of Congress Tuesday, the American Hospital Association said they could not support the bill on the grounds that it lacks a Congressional Budget Score and rolls back Medicaid expansion.
"It appears that the effort to restructure the Medicaid program will have the effect of making significant reductions in a program that provides services to our most vulnerable populations, and already pays providers significantly less than the cost of providing care," AHA President Richard Pollack said in the letter.
Instead of pushing Medicaid management down to the states, Pollack said it would be better to expand the existing waiver program to encourage more innovative Medicaid designs.
"The expanded use of waivers - with appropriate safeguards - can be very effective in allowing state flexibility to foster creative approaches and can improve the program more effectively than through imposing per-capita caps," he said.
"In addition, the legislation repeals much of the funding currently dedicated to provide coverage in the future. Furthermore, we object to eliminating the funding from some sources, but leaving in reductions to payments for hospitals services. If coverage is not maintained at the current level, those resources need to be returned to hospitals and health systems in order to provide services to what will likely be an increased number of uninsured Americans," he said.
On Wednesday, leadership from America's Essential Hospitals sent a letter to chairmen of the House Ways and Means and the Energy and Commerce Committees to air their concerns about the bill and request that it be pulled from consideration.
"With fewer than two full days between public release of the bill and consideration in the committees, we are disappointed we have not been given sufficient time to analyze and model the impact of the bill," wrote CEO Bruce Siegel.
Markup of the bills began Wednesday in both committees.
Siegel also decried the lack of CBO score being available before markup and debate over the bill and took issue with how the Republican bill handles Medicaid.
"While the bill would allow states to continue to cover those people under a standard federal match, we are concerned that many will choose not to do so. In short, this provision will almost certainly mean many people currently covered will lack coverage in the future," he said.
While the bill would end the subsidies in the ACA and instead replace them age-based tax credits to help Americans pay for their insurance, Siegel argued that the math doesn't line up with the financial need facing affected families and individuals.
"We are concerned that the size of the tax credits -- just $2,000 to $4,000, depending on age--appear to be substantially below the actual costs of purchasing a comprehensive health care plan. We believe that, without additional support, millions of people might be unable to afford coverage, driving up the ranks of the uninsured and increasing uncompensated care at our hospitals."
America's Essential Hospitals, however, did express support for the bill's reinstatement of Medicaid disproportionate share hospital payments.
"While Congress has wisely chosen to delay these cuts--which amount to $42 billion over the next 10 years -- essential hospitals have continued to live under the cloud of a future DSH cliff. This legislation ultimately removes that cloud and would help essential hospitals meet their missions."
However, Siegel did say the bill didn't go far enough.
"We are disappointed that the bill would allow the initial cuts to go into effect for two years for states that expanded Medicaid under the ACA. We urge the committee to fully eliminate the cuts for all states," he said.