Democratic leaders, healthcare providers, and patient advocates are continuing their spirited opposition to the latest Republican healthcare plan, which would likely end coverage for some 560,000 people in New Jersey. The vote on the latest version of the bill, which critics expect to hit the state particularly hard, was delayed again by GOP leaders this past weekend.
“This fight is not just a fight over healthcare. It’s a fight over the very values that are central to our democracy,” New Jersey Democratic Sen. Cory Booker insisted at a rally with other elected officials, labor leaders, and activists held outside the U.S. Capitol Monday.
While the latest version of the legislation includes an additional $43 billion over 10 years to help states address the opioid epidemic, critics said it would still eliminate hundreds of billions in federal dollars for Medicaid and commercial insurance subsidies — changes that could leave as many as 22 million people without coverage by the end of the decade. The new reforms, unveiled by Senate leaders last week, were an effort to attract support for the plan.
It was, however, reported late yesterday that Republicans once again could not muster backing for the bill, which has collapsed.
NJ would be hit hard
For New Jersey, the bill could end coverage for 10 percent of all adults under age 65 and cost the state more than $60 billion in federal Medicaid dollars over the next two decades. It would also eliminate tens of thousands of healthcare jobs, according to New Jersey Policy Perspective, a progressive research group, which will mean the state economy will take a hit.
Kentucky Sen. Mitch McConnell, the Senate leader, had initially hoped to host a vote on the measure this week, but announced late Saturday that action would be delayed until Sen. John McCain (R-AZ), returned to Washington following a sudden surgery he underwent Sunday to remove what is believed to be a blood clot near his eyebrow. Several senators have already announced they will not support the proposal and McConnell needs all other GOP members on board for it to pass under the current rules.
At the Washington, D.C., rally, “The People’s Filibuster to Stop Trumpcare,” coordinated by the liberal group MoveOn.Org and several labor unions, New York Sen. Chuck Schumer, the Senate’s top Democrat, urged McConnell to use the extra time to hold public hearings on the bill, sparking cheers.
‘Kill this bill’
Booker also roused the crowd by comparing the healthcare battle to epic fights for equal rights and told participants “this is our call” to make a difference in America’s future. “We cannot say we are a success (as a nation) when millions go without healthcare,” he added. “We must kill this bill.”
The most recent version — with new funding for addiction programs to appeal to moderate Republicans and additional regulatory freedom for insurance companies to attract support from conservatives — was designed to overcome this narrow margin after an earlier draft failed last month to secure the votes needed to pass. McConnell had originally hoped to move the bill before the July 4 holiday, but faced a growing defection when members raised concerns about how it was likely to shift significant costs to states, reduce access to care, or both.
“This latest proposal is like a splash of cologne on a skunk; it still stinks,” said New Jersey’s senior senator, Democrat Bob Menendez, after it was introduced last week. Menendez was particularly concerned with a change that would enable insurance companies to sell bare-bones policies — including those that don’t cover maternity care, behavioral healthcare, or other pre-existing conditions — as long as they also offered a comprehensive plan in the same market.
‘Cruel, misguided, and partisan’
“Revision after revision, the destructive impact of the Republican health bill remains the same: millions of Americans go uninsured and consumers pay higher premiums and deductibles for less coverage,” Menendez said, urging the GOP to “listen to the overwhelming majority of Americans who want them to abandon their cruel, misguided, and partisan repeal effort once and for all.”
Any legislation approved by the Senate will then need to be reconciled with a version approved by the U.S. House of Representatives in early May. While that measure is similar in many ways to the Senate bill, it includes a different timeline for funding changes to Medicaid and other regulatory changes for the commercial insurance market.
Republicans have targeted Obamacare for years, arguing that the Medicaid expansion under the landmark 2010 law — which added 500,000 to New Jersey’s public insurance rolls — is financially unsustainable. They also complain that the law’s regulatory restrictions on insurance companies — which allowed another 300,000 to get policies in the Garden State —have created an unstable market that, in some states, has left customers with only one choice in carriers.
By the numbers
According to an initial analysis by the nonpartisan Congressional Budget Office, the Senate plan would reduce the current plans for Medicaid spending $772 billion over 10 years and eliminate $408 billion in spending now used to help low-income workers who don’t get healthcare through their employer to purchase commercial policies. Regulatory changes would also hike the price of commercial plan premiums by 20 percent in a year and 30 percent by 2020, while out-of-pocket costs would nearly double, on average, to $6,000 a year for most customers.
Those predictions have sparked fears nationwide. Patient advocates have worried about the loss of insurance coverage for Medicaid patients; state officials are concerned about the impact on their own finances; and some insurance experts have suggested the proposed reforms would only further destabilize the commercial market.
Under the plan, the federal government would provide states a specific amount for each Medicaid patient per year, based on previous spending; the current system pays a fixed portion of all covered care, without a fixed cap on spending.
Healthcare providers have also raised red flags about the Republican proposals, which they have said will drive up the cost of treating patients who lack health insurance. The Medical Society of New Jersey joined nine other state-based provider groups to oppose the latest Senate version, in part because it doesn’t include enough to cover Medicaid inflation over time.
“States cannot absorb these tremendous costs,” the Coalition of State Medical Societies wrote, warning that some will further cut already limited payments to physicians, which will result in other problems. “Access to care is a challenge for Medicaid patients now, and this proposal will only make it worse. Moreover, a public health crisis, such as a Zika virus outbreak or another Hurricane Katrina, could devastate state Medicaid budgets under a cap,” the group said.
An analysis by the AARP also raised concerns about the cuts to Medicaid, which covers nursing home care, home health care and other long-term services for millions of elderly and disabled Americans. Federal dollars for home and community-based services — the least expensive and preferable option for most families — would decline 22 percent, or $46 billion, under the GOP plan.
All states will be left without enough to cover those services in the future, the AARP warned, with Arizona losing more than half of its federal dollars for home-based care. Florida and Delaware would need to cut or cover one-third of their current spending to make up the difference. New Jersey fares relatively well, standing to lose only 16 percent of its federal dollars — but would still face a loss of nearly $864 million over 10 years.