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Opposition To GOP Repeal Bill Inches Up And Intensifies
Public opposition to the Republican effort to replace the Affordable Care Act grew stronger this month, but a core group of Republicans remained in support, according to a poll released Friday.
Sixty-one percent of the public said this month they did not like the GOP health care effort, now undergoing a revised push in the Senate. That was a 6 percentage point increase from the Kaiser Family Foundation’s monthly tracking results in June, when 55 percent expressed unfavorable opinions. (Kaiser Health News is an editorially independent program of the foundation.)
The poll also found opposition was becoming more passionate, with more of the public viewing the plan “very” unfavorably. The Affordable Care Act maintained the support of half the populace, nearly double the 28 percent of people who backed the GOP efforts. Two of three people opposed major reductions in Medicaid that are included in the GOP plan…
Nonetheless, a majority of Republicans and supporters of President Trump continued to favor the GOP plan, which would increase the number of uninsured as it alters Medicaid and the private insurance markets that have been running since 2014. In fact, in this month’s poll more Republicans said health care is headed in the right direction than believed that in April, before the House passed its version of the health care replacement bill.
Still, most Americans said they would prefer Republicans and Democrats to work together on health care — 71 percent said they would like to see a bipartisan effort to fix the ACA.
The poll of 1,187 adults was conducted July 5 – 10, about a week after the Congressional Budget Office issued its report on the GOP draft legislation. The margin of error was plus or minus 3 points.
Lahey, Beth Israel and others ink merger agreement to create 13-hospital system
Five Massachusetts hospitals and health systems have signed a definitive agreement to merge.
The agreement was signed by two Boston-based organizations — Beth Israel Deaconess Medical Center and New England Baptist Hospital — as well as Burlington, Mass.-based Lahey Health, Mount Auburn Hospital in Cambridge, Mass., and Anna Jaques Hospital in Newburyport, Mass.
Under the agreement, the hospitals will operate under a parent organization but retain their names, licenses and independent boards.
The deal, which requires regulatory approval, would create the second largest health system in Massachusetts, according to the Boston Business Journal.
This is the first time Beth Israel and Lahey have signed a definitive agreement, but it marks the fourth time they’ve tried to merge.
In addition to the 13 hospitals, the new system would include 800 primary care physicians and more than 3,500 specialists.
CEOs of Ascension, Dignity, Trinity, Providence, CHI to Trump, Congress: Work with us on healthcare legislation
The leaders of five major nonprofit health systems are calling on Congress to work with them and draft healthcare legislation that encourages improved quality of care and ensures Americans maintain their insurance coverage, according to an op-ed penned in The Hill.
Anthony Tersigni, EdD, president and CEO of St. Louis-based Ascension, Kevin Lofton, CEO of Englewood, Co.-based Catholic Health Initiatives, Lloyd Dean, CEO of San Francisco-based Dignity Health, Richard Gilfillan, MD, CEO of Livonia, Mich.-based Trinity Health, and Rodney Hochman, MD, CEO and president of Renton, Wash.-based Providence St. Joseph Health all emphasized the need for Congress not to pass the Better Care Reconciliation Act as it is written and risk millions of Americans losing their health insurance.
“Together, we can fix this,” the CEOs wrote. “There is still plenty of room for improvement in our healthcare system. Healthcare is too expensive, coverage must be more affordable, Medicaid programs must become more innovative and efficient, the individual market must be stabilized and more payments for healthcare services must be made through value-based contracts.”
“…we invite the Trump administration and members of Congress to work together with us to create a health system that always puts people first and never forgets that each of us is only one disease or one accident away from vulnerability, ” wrote the group.
The CEOs’ organizations combined have a presence across 40 states and Washington, D.C.
Five key senators who will make or break healthcare reform
The fate of Republican legislation to repeal and replace major parts of ObamaCare rests on a handful of senators who have strong reservations about the bill and a variety of political reasons to either support or oppose it.
Two Republicans have already said they will vote against a motion to proceed to the bill next week, giving Senate Majority Leader Mitch McConnell (R-Ky.) no margin for error.
If one more GOP senator defects, the bill will fail and party leaders will have to go back to the drawing board or altogether shelve the healthcare reform effort
The Congressional Budget Office score of the bill, expected on Monday, could tip the balance one way or the other — as could pressure from President Trump, their home-state governors, doctors and hospitals.
Sen. Dean Heller (R-Nev.)
Heller has the most on the line as the most vulnerable Republican senator up for re-election in 2018.
A survey last month of 500 registered voters in Nevada by a GOP polling firm found that a majority of Nevadans opposed the House-passed healthcare bill, which the Senate legislation is largely based on. The poll found that only a third of Nevada Republicans supported the House legislation.
Meanwhile, Republican Governor Brian Sandoval, the most popular politician in the state with a 64 percent approval rating has come out strongly against the Senate measure.
Heller appeared with Sandoval at a press conference last month to announce his opposition to the bill McConnell unveiled on June 22, telling reporters “it’s going to be very difficult to get me to a ‘yes.’”
Sandoval said Thursday that he is “greatly concerned for the 204,000” Nevadans who received health coverage under ObamaCare’s Medicaid expansion.
He also said the revised bill unveiled earlier that day “isn’t that much different from its previous iteration.”
Voting for the bill could be a major liability for Heller.
On the other hand, if he sinks it, he could still pay a price at the polls as Trump has warned Wednesday he will be “very angry” if the Senate does not pass the healthcare bill.
Running against Trump did not work for GOP candidates in Nevada last year, even though Hillary Clinton carried the state. Former Rep. Joe Heck (R-Nev.) and former Rep. Crescent Hardy (R-Nev.), who both disavowed Trump, lost races for Senate and House seats, respectively.
Sen. Lisa Murkowski (R-Alaska)
An underrated element in Murkowski’s decision making is her past relationship with McConnell and the broader Republican Party.
McConnell kicked Murkowski off his leadership team in 2010 after she lost Alaska’s Republican primary to conservative candidate Joe Miller.
McConnell at the time urged Murkowski to accept the result of the primary and “move on.” He also made a $5,000 donation to Miller’s campaign.
Murkowski nevertheless won the general election as a write-in candidate by relying on independent and cross-over Democratic votes.
The Senate healthcare bill is particularly unpopular with independents and Democrats and its reductions in healthcare subsidies and Medicaid would hit Alaska’s rural population and expensive insurance markets especially hard.
The Center for Budget and Policy Priorities, a liberal-leaning think tank, concluded this month that the first version of the Senate healthcare bill would reduce tax credits more deeply for Alaskans than people in any other state.
The revised version unveiled Thursday includes a new provision that could allocate more than $1 billion over the next decade to Alaska to reduce the cost of insurance premiums.
Murkowski applauded the inclusion of the language Thursday but declined to say whether she would vote to advance the bill next week.
She has criticized the legislation for setting a lower formula for indexing Medicaid for inflation starting in 2025, arguing it has gone beyond the stated mission of repealing and replacing parts of ObamaCare.
“Let’s leave Medicaid off the table for right now. Let’s bifurcate this,” she told reporters Wednesday. “This is not something that in my view is best done in a reconciliation process.”
Moderate Rep. Susan Collins (R-Maine), who has pledged to oppose the motion to proceed to the bill, made a similar argument against changing funding for traditional Medicaid beneficiaries, noting that ObamaCare “did not rewrite the entitlement program.”
Sen. Mike Lee (R-Utah)
Lee partnered with Sen. Ted Cruz (R-Texas) in pushing an amendment to allow insurance companies to sell any health plans of their choosing as long as they offer at least one that meets ObamaCare’s regulatory requirements.
Cruz announced Thursday he would support the Senate bill after negotiating a side deal with the leadership to amend the Cruz-Lee Consumer Freedom option — but he left Lee out of the talks.
Lee tweeted Thursday morning that the language added to the bill was “based” on the Cruz-Lee amendment but is not the same thing and is so far undecided on how to vote.
It will be tougher for Lee to vote to block the legislation now that two of his fellow conservatives, Cruz and Sen. Ron Johnson (R-Wis.), have flipped from opposing the legislation to now supporting a motion to begin debate.
Cruz agreed to modify the amendment by fusing the risk pools of people who buy cheaper plans subject to less federal regulation and those who purchase costlier federally qualified plans.
Lee has held firmly to the position that the costs of plans for people with pre-existing conditions should not be kept low, something that requires healthy people to bear more financial burden. In private meetings he explicitly objected to ObamaCare’s so-called community rating requirement, which keeps plans affordable to people with pre-existing conditions.
Whether he buys into the compromise Cruz struck with leaders could depend on what the CBO says of its impact on premiums.
Some lawmakers raised questions on Thursday about whether the CBO would provide an analysis for the Cruz amendment before the vote on the motion to proceed. Sen. Bill Cassidy (R-La.), however, who has been active in the internal talks, said he was assured that senators would get a CBO score on the Cruz provision before the vote.
Shelley Moore Capito (R-W.Va.)
Capito’s home state has a lot riding on the proposed Medicaid reforms.
Twenty-nine percent of West Virginia’s population is on Medicaid, making it the state with the highest share of its population relying on the program, according to the Kaiser Family Foundation.
More than a third of the state’s total enrollees, 180,500 adults out of 564,000 people, signed up under ObamaCare’s expanded enrollment.
A poll conducted for the American Medical Association last month found that only 19 percent of 400 West Virginia voters surveyed approved of the House-passed healthcare bill while 42 percent disapproved.
The Senate bill adopts a less generous formula for indexing Medicaid to inflation starting in 2025 by pegging it to inflation for urban consumers instead of medical inflation, which grows at a faster rate.
Capito told reporters Thursday that the CBO score will factor heavily in her decision.
Capito has a closer relationship with McConnell than some of the other GOP holdouts. She serves on his leadership team as counsel.
Sen. Rob Portman (R-Ohio)
Portman has historically had a close relationship with McConnell but things are getting tense between the two men because of the healthcare debate.
McConnell and Portman clashed at a leadership meeting last month when McConnell pointedly reminded his colleague that he supported entitlement reform when serving as budget director for former President George W. Bush.
Portman easily won re-election last year in a swing state that was expected to be closely contested but that Trump carried by 8 points.
But Portman is feeling pressure from Ohio Gov. John Kasich (R), who came out against the Senate bill Friday, calling it “unacceptable” and its Medicaid cuts “too deep.”
Portman, however, is not as closely aligned with Kasich as Heller is with Sandoval in Nevada.
From early on in the negotiations, Senate Republicans suspected Kasich was trying to blow up the negotiations because of his own political aims.
Nearly 700,000 people gained healthcare coverage in Ohio under Obama’s Medicaid expansion.
Portman has long argued for a longer glide path for phasing out generous federal funding for expanded enrollment and expressed concerns about the less generous inflation rate.
He was given a big concession in the revised bill when McConnell included an $45 billion in the revised bill to cover people addicted to opioids, an epidemic in Ohio.
Insurers shred Senate health care bill: “Premiums will skyrocket for preexisting conditions”
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Health insurance companies have largely bit their tongues about the Senate health care plan, but they are turning against it now, warning that a recent revision would send premiums skyrocketing for people with high medical costs.
The insurance industry has been one of the few health care sectors to even tentatively embrace the Senate’s plan, as Vox has documented, but that has changed in the last few days. Their most influential representatives in Washington — America’s Health Insurance Plans and the Blue Cross Blue Shield Association — sent a letter to Senate leaders Friday urging them to remove Sen. Ted Cruz’s amendment from the legislation.
The Cruz amendment, added in the revised Senate plan, would allow health plans to sell insurance on the individual marketplaces that does not comply with Obamacare’s insurance regulations as long as they also sold plans that did comply. Outside experts have warned this would segment the market, with healthy people buying skimpier non-Obamacare coverage and sicker people buying more robust Obamacare plans.
That would then send costs, and in turn premiums, spiraling upward in the Obamacare market, the insurance trade associations warned in their letter. They noted particularly that middle-class families who do not qualify for financial assistance would not be shielded at all from those increasing premiums.
“As healthy people move to the less-regulated plans, those with significant medical needs will have no choice but to stay in the comprehensive plans, and premiums will skyrocket for people with preexisting conditions,” the groups said.
The Senate does include $70 billion to offset increased costs under the Cruz amendment. But that money does not appear to be enough to assuage the insurance industry’s concerns.
“Finally, this provision will lead to far fewer, if any, coverage options for consumers who purchase their plan in the individual market,” the groups said. “As a result, millions of more individuals will become uninsured.”
It is unclear whether the Cruz amendment will be evaluated as part of the Congressional Budget Office score of the Senate bill to be released this coming week. A source familiar with the situation told me that the US Department of Health and Human Services office of planning and evaluation has been asked to review the proposal and its cost and coverage implications.
The insurance groups urged Senate Republicans leaders to remove the Cruz provision from the legislation.
Dave Dillion, an expert with the Society of Actuaries, told me Friday that part of the insurance industry’s objections is likely the uncertainty that the Cruz plan would introduce to the insurance market.
“I think while obviously a lot of carriers have not been enthralled with [Obamacare], you get comfortably number, you know the rules, and you go on about your business,” he said, adding of the Cruz proposal: “There’s so much uncertainty about what it really means. It’s not black and white.”
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