If the Better Care Reconciliation Act (BCRA) lived up to its title, why are so many healthcare providers and patient groups opposed to the bill? Attempts to fix the bill have not changed the fact that, if it passes, millions of Americans would lose health insurance. That’s because it would weaken both Medicaid and the individual health insurance market. Tweaks and extra money in a few areas will not stop the harm to patients, our healthcare system and public health.
Governors and senators are being told that more flexibility in Medicaid would allow states to better use federal funds and help vulnerable patient populations. But cutting federal Medicaid spending by over $700 billion will not foster better care for patients. Governors and state health officials all know that steep Medicaid cuts would force states to take away coverage, cut benefits and slash provider payments. A letter from the bipartisan National Association of State Medicaid Directors made the point well: “No amount of administrative or regulatory flexibility can compensate for the federal spending reductions that will occur as a result of this bill.”
The importance of the healthcare safety net provided by Medicaid cannot be overstated. For example, Medicaid serves more than 2.3 million Americans with a history of cancer, including one-third of all childhood cancer patients at the point of diagnosis.
In addition, approximately one-third of all patients on Medicaid have cardiovascular disease and use this critical program to get access to treatment and disease management services. Medicaid also covers one-third of all opioid addiction treatments. While the bill would invest $45 billion into stand-alone opioid treatment, these individuals often have other healthcare needs that would go unaddressed.
The BCRA would also fail to make private health insurance more affordable. That’s because, under this bill, consumers would get less help with their premiums than under current law. In 2020, subsidies that help many Americans with deductibles and co-payments would be eliminated. And that’s only one example of how consumers would see much higher costs. Several respected policy analysts, including at the independent Congressional Budget Office, have concluded that some extra money for “stabilization and innovation initiatives” won’t make up for the tens of millions who would lose insurance. Further, many of the people would show up at hospitals in need of care, won’t be able to pay the bill, and drive costs higher for everyone else.
Two major health insurance groups have warned that proposals to allow health plans to offer bare bones policies will create serious problems. Effectively, the insurance market would be split in two. People who want and need comprehensive coverage would see sharply higher rates. People with pre-existing conditions would be hardest hit. In addition, the BCRA may bring back annual and lifetime caps on insurance coverage for individual market and employer-based plans.
Public opinion polls consistently show widespread voter opposition to the “repeal and replace” bills that have been proposed. Moreover, large majorities of voters want protect or increase Medicaid funding.
Yes, there are problems with some aspects of the current health law. The most immediate need is to provide stability in the individual market. Republicans and Democrats have expressed an interest in pursuing remedies on a bipartisan basis, and we urge them to start down that path now. Longer term, our nation needs to address the greatest challenge in healthcare: unsustainable trends in healthcare costs.
We are ready to work on both short- and long-term solutions. We strongly urge the Senate to reject pending repeal proposals and to pivot to a more constructive bipartisan approach.
Nancy LeaMond is Executive Vice President and Chief Advocacy & Engagement Officer of AARP, Chris Hansen is president of the American Cancer Society – Cancer Action Network, Nancy Brown is CEO of the American Heart Association, David O. Barbe, MD, is president of the American Medical Association.
The views expressed by this author are their own and are not the views of The Hill.