Saturday, February 24, 2018
Health

GOP's new repeal bill would likely leave millions more uninsured, analyses suggest

WASHINGTON — The latest Republican bid to roll back the Affordable Care Act would likely leave millions of currently insured Americans without health coverage in the coming decades, and strip benefits and protections from millions more, a growing number of independent studies suggest.

Health care safety nets in dozens of states stand to lose more than $200 billion by 2026 and hundreds of billions of dollars more in the years that follow, the analyses indicate.

And while the magnitude of the coverage losses is difficult to quantify because the new GOP proposal — authored by Sens. Lindsey Graham, R-S.C., and Bill Cassidy, R-La., — leaves crucial details to be determined, studies of similar proposals suggest tens of millions of Americans would see major changes to their health coverage.

"The vast majority of states lose money, and some lose truly jaw-dropping amounts," said Jocelyn Guyer, managing director of Manatt Health, a consulting firm that has analyzed the Graham-Cassidy proposal.

"That suggests coverage losses that are likely somewhere between significant and vast," she said.

Analyses by other experts — including consultant Avalere Health, the nonprofit Kaiser Family Foundation and the Center on Budget and Policy Priorities, a left-leaning think tank — reach similar conclusions, suggesting the bill would likely erode the historic insurance gains recorded in recent years.

Since 2014, when the current health law was fully enacted, more than 20 million previously uninsured Americans have gained coverage, driving the rate of uninsured to the lowest levels ever recorded.

Fitch Ratings added its own caution, warning in a report that states would face significant "budgetary challenges" under the GOP proposal, which, in turn, could put pressure on state support for schools, cities and colleges and universities.

GOP leaders have issued repeated assurances in recent days that the Graham-Cassidy bill would not erode protections extended by the 2010 law, often called Obamacare.

"More people will have coverage, and we protect those with pre-existing conditions," Cassidy said Wednesday in an interview with CNN.

But as they rush to vote, Republican lawmakers are not waiting for an independent analysis by the Congressional Budget Office, or CBO, which lawmakers customarily rely on to asses the impact of large, complex bills. A spokeswoman for Senate Majority Leader Mitch McConnell, R-Ky., told Politico on Wednesday that McConnell is planning a vote next week.

President Donald Trump added his encouragement from New York, where he is attending the U.N. General Assembly.

"They're going to do a great job," the president told reporters, noting many GOP lawmakers had been embarrassed by their inability to pass a repeal bill. "If this happens, it will be a great thing for the country."

CBO analyses of previous GOP repeal plans have estimated coverage losses of 20 million or more.

And Republicans' claims about the current bill are contradicted by virtually every independent analysis, as well as assessments by leading patient advocates, hospital groups, insurers and physicians.

No major group representing patients or people who work in the health care system backs the Graham-Cassidy proposal.

Even health insurers that have largely remained quiet in this year's repeal debate publicly criticized the GOP plan Wednesday.

The Blue Cross Blue Shield Association cautioned the plan would likely destabilize insurance markets, "making coverage more expensive and jeopardizing Americans' choice of health plans."

Also joining opposition to the bill Wednesday was New Jersey Gov. Chris Christie, who warned that Graham-Cassidy would hurt residents of his state.

Christie, who heads the president's opioid commission, was the seventh GOP governor to publicly oppose the proposal. Fifteen Republican governors sent a letter this week backing Graham-Cassidy.

Late-night TV host Jimmy Kimmel jumped into the debate as well, deriding Cassidy in his monologue Tuesday for going back on a promise he made to Kimmel earlier this year that he would not back any plan that didn't protect sick Americans.

"This guy, Bill Cassidy, just lied right to my face," said Kimmel, who earlier this year recounted his newborn son's congenital heart condition in an emotional discussion about the importance of robust insurance protections.

Previous studies by the Congressional Budget Office have concluded that proposals like Graham-Cassidy, which gives states authority to waive insurance protections and allow insurers to charge sick consumers more, would result in substantial coverage losses.

The centerpiece of the GOP bill is a new system for distributing hundreds of billions of dollars of federal money that would restructure how the government provides health care assistance to some 80 million Americans.

That would represent the nation's largest change in the way health care is financed in more than half a century.

The bill would effectively end both the current Medicaid program, which covers poor Americans, and the system of insurance subsidies made available by the 2010 health care law to help low- and moderate-income consumers buy health plans.

In place of these programs, the federal government would give states blocks of money to redesign their health care safety net, while also capping future federal support for states.

The expanded flexibility would allow states to create better programs that cost less, Graham and Cassidy have said.

But any benefits from more flexibility would likely be outweighed by the very large reductions in aid, said Dan Mendelson, president of Avalere Health, which calculated that Graham-Cassidy would reduce federal funding to states by $215 billion over the next decade.

"This is a substantial cut to Medicaid funding and no one should be unclear about that," he said. "There would undoubtedly be major coverage losses in places like California, where the state would not be able to support continued coverage expansion."

States like California, which have moved aggressively to expand coverage through the 2010 law by expanding Medicaid eligibility and investing in a robust insurance marketplace, stand to lose the most under Graham-Cassidy, Avalere and others suggest.

Other blue states that have traditionally offered strong health care safety nets also stand to lose billions. So, too, do a number of red states that have expanded coverage through the 2010 law, including Arkansas, Arizona, Kentucky, Louisiana and Ohio.

States that have not expanded coverage stand to gain money in the short term because of a formula in Graham-Cassidy that effectively reallocates money between states.

But over the long term, all states will see cuts, Fitch and other analysts noted.

That is true particularly after 2026, when Congress would have to find more than $1 trillion to continue federal health care aid to states.

"There is no guarantee of whether and at what level federal funding would be available beginning in 2027," Manatt Health notes in its analysis.

Lisa Mascaro in Washington contributed to this report. ©2017 Los Angeles Times

Comments
Mental illness dominating post-Parkland gun debate, but at what cost?

Mental illness dominating post-Parkland gun debate, but at what cost?

A familiar and polarizing tug of war over gun control and access to guns has re-emerged in the week since the massacre at Marjory Stoneman Douglas High School in Parkland, thrusting mental illness once again into the national conversation about mass ...
Updated: 5 hours ago
After Parkland, admissions to mental health treatment centers in Florida spike

After Parkland, admissions to mental health treatment centers in Florida spike

The emotional welfare of children follows predicatable patterns. In the fall, when school begins, beds at psychiatric treatment centers fill up. They empty again during summer break and the winter holidays.In recent years, doctors and psychologists h...
Published: 02/24/18
Doctors ordered a urine test after her surgery. That’ll be $17,850, the lab said

Doctors ordered a urine test after her surgery. That’ll be $17,850, the lab said

This is the debut of a monthly feature from Kaiser Health News and NPR that will dissect and explain real medical bills in order to shed light on U.S. health care prices and to help patients learn how to be more active in managing costs. Do you have ...
Published: 02/21/18
Updated: 02/22/18
Preventive treatment for peanut allergies succeeds in study

Preventive treatment for peanut allergies succeeds in study

The first treatment to help prevent serious allergic reactions to peanuts may be on the way. A company said Tuesday that its daily capsules of peanut flour helped sensitize children to nuts in a major study. Millions of children have peanut allergies...
Published: 02/20/18
Doctors were wrong when they told her immunotherapy wouldn’t cure her cancer

Doctors were wrong when they told her immunotherapy wouldn’t cure her cancer

No one expected the four young women to live much longer. They had an extremely rare, aggressive and fatal form of ovarian cancer. There was no standard treatment.The women, strangers to one another living in different countries, asked their doctors ...
Published: 02/20/18

Hernando Bloodmobile for Feb. 23

Bloodmobile locationsLifeSouth Community Blood Center will have blood drives at the following off-site locations during the coming week:Feb. 23: 10 a.m. to 3 p.m., Walmart, 13300 Cortez Blvd., Spring Hill; 10:30 a.m. to 5:30 p.m., Dickey’s Barbecue P...
Published: 02/20/18
Be prepared to help save a life: Learn CPR

Be prepared to help save a life: Learn CPR

70 percent of cardiac arrests outside hospitals happen at home. American Heart Association 3 a.m. Jan. 4, 2016. Lisa Peters of St. Petersburg is awakened by her husband, Rick, making strange gasping sounds. She can’t wake him. He feels cold. Only 46...
Published: 02/16/18

Step by step, ramp up your daily activity

Jae Bermanhe Washington Post There are many reasons that people avoid exercise. Time is an obvious one. Our lives are already busy — who has time to work out? Money is another common excuse. Gym memberships and equipment can get pricey.People often w...
Published: 02/16/18
Put Alaskan king crab leg shells to work in a creamy, dreamy bisque

Put Alaskan king crab leg shells to work in a creamy, dreamy bisque

Nothing says indulgence like noshing on some seriously giant Alaskan king crab legs. They’re not just tasty, they’re a low-fat source of protein: One leg has about 25 grams of protein and a host of vitamins and minerals (including sodium, incidentall...
Published: 02/15/18
Avocado toast gets a persimmon twist

Avocado toast gets a persimmon twist

You’ve likely seen persimmon in the grocery store and then shied away from it, not quite sure what to do with it. The most common variety in the United States is the fuyu persimmon, also called Japanese persimmon, and it looks similar to a slightly f...
Published: 02/15/18