Powerful industry groups are taking sides in the politically charged fight over repealing and replacing ObamaCare.
Healthcare associations, including those representing doctors and hospitals, have largely come out in opposition to the legislation from House Republicans. Meanwhile, some of the nation’s largest business groups have expressed support for it.
Major hospital groups, including the American Hospital Association and a larger coalition of hospitals called America’s Hospitals and Health Systems, have written letters to Capitol Hill slamming the legislation and urging members to oppose it.
Doctors, through the American Medical Association (AMA), joined that chorus on Wednesday morning, calling the bill “critically flawed.”
Other major players — including seniors advocacy group AARP and health organizations from the advocacy arm of the American Cancer Society to the March of Dimes — have also panned the bill.
But Republicans pushing the legislation are unfazed by the criticism, charging the groups are simply to seek to protect the benefits they received from the Affordable Care Act.
White House press secretary Sean Spicer on Wednesday pushed back, saying the legislation isn’t aimed at winning over special interests.
“We would love to have every group on board, but every single deal we heard about getting through [in ObamaCare] … over and over again, it was one deal after the other, to buy votes to get it through the Senate,” he said, in response to questions about criticism from the AMA and AARP.
“If you want to line up how many special interests that got paid off last time versus now, they’ll probably win, hands down,” he added. “This isn’t about how many special interests in Washington we can get paid off, it’s about making sure that patients get the best deal that lowers prices.”
Many industry and patient groups are charging Republicans with the opposite: making care more expensive and harder to pay for, in addition to potentially taking away coverage from millions of Americans.
“Although no one believes the current healthcare system is perfect, this harmful legislation would make healthcare less secure and less affordable,” said Nancy LeaMond, AARP’s executive vice president, in a statement on Tuesday night.
Many healthcare groups are particularly upset with the proposed changes to Medicaid, which would repeal the federal funds used to expand of the program through ObamaCare after 2020 and restructure the program to cap federal payments. Groups warn that change would lead to damaging cuts.
Other concerns include changes to the tax credits that Republicans are proposing to help people buy insurance. (While ObamaCare bases these credits on income, the GOP alternative primarily uses age as a metric.)
Meanwhile, conservative organizations outside Congress — such as Heritage Action and Club for Growth — are arguing that the changes to ObamaCare don’t go far enough.
Proponents of the legislation, such as the U.S. Chamber of Commerce, which represents a large swath of the business community, have applauded the GOP’s plan to scrap the taxes created by ObamaCare, including ones placed on health insurance plans, medical devices and tanning beds.
Americans for Tax Reform, an influential group helmed by Grover Norquist, is also backing the measure.
America’s Health Insurance Plans — run by Marilyn Tavenner, a former head of the Centers for Medicare and Medicaid Services and an architect of ObamaCare — on Wednesday sent a letter to House Republicans offering suggestions for changes to the legislation, while not opposing it outright.
The letter also mentions Medicaid changes as an issue and calls for more robust tax credits, which factor in both age and income.
It remains to be seen how much the outside pressure will do to shift the debate on Capitol Hill, particularly in the Senate, where centrists are wary of the changes to Medicaid.
But the lobbying right now is primarily focused on the House, said Jennifer Bell, the co-founder of Chamber Hill Strategies, who has worked for Republicans on both health and tax-writing committees.
“The next two weeks or three weeks is make or break. If it passes the House, how it passes can be very indicative of what a strategy might be in the Senate,” she said.
“If it narrowly passes, does the Senate get cold feet? If conservatives and moderate Republicans come together in the House to pass the bill, does the Senate have sound footing to pass the bill as is, without major changes?”
The legislation is small by congressional standards, coming in at roughly 120 pages — a fact that Spicer highlighted during the daily press briefing on Tuesday.
“For all of the people who have concerns about this, especially on the right, look at the size,” Spicer said, pointing to two stacks of paper on a table next to him.
“This is the Democrats, this is us,” he said, gesturing to printouts of ObamaCare and the American Health Care Act, with the Affordable Care Act dwarfing the GOP healthcare plan.
“There is — I mean, you can’t get any clearer in terms of this is government, this is not,” Spicer concluded.
Much of the GOP legislation consists of striking down parts of the Affordable Care Act, which requires only a few lines of text.
Republican leaders have not yet indicated how far they are willing to go in changing the bill, having sought to reach a careful compromise that they hope can win broad support in the party.
“It’s very delicate surgery from [lawmakers’] perspectives. There’s not the traditional room you have in the legislative process to accommodate people and bend the product to meet the pressure,” said John Jonas, a lobbyist at Akin Gump who leads the firm’s healthcare policy group, referring to the special legislative process, called reconciliation, being used to pass the bill.
Bills going through reconciliation may only contain provisions that affect the federal budget.
However, taking a stand early on in the process is essential because more legislation and additional regulations and guidance from the administration.
The insurance industry, for example, is concerned that some of the ObamaCare provisions allowing the federal government to oversee the insurance marketplace — such as the ability to set certain standards for coverage on state exchanges — will stay in place under the GOP bill, according to one industry source who does not have the authority to speak on the record.
Even though this administration likely wouldn’t use those powers, insurers fear that a Democratic administration would.
There is language floating around Capitol Hill to fully repeal the federal government’s ability to set standards and manage the state insurance exchanges, according to a document obtained by The Hill.
However, it is unclear whether those changes would directly affect the budget and therefore be eligible for inclusion in the reconciliation bill.
There are many other unanswered questions about how reform will proceed, including how it will be funded, leaving a door open to outside groups who want to exert influence.
“At the end of the day, this bill that’s out there isn’t the bill that’s going to get passed,” said the industry source.
“They know it’s not perfect, but they’re forcing action and debate on stuff,” the person said.