As the U.S. Senate this week careens toward dismantling Obamacare, moderate Republicans must step up to halt the reckless action that also would make the deepest cuts to Medicaid since the health insurance program for poor people was established in 1965.
Republicans for the past seven years have campaigned to repeal the Affordable Care Act signed into law in 2010 by former president Barack Obama. Known as Obamacare, it has increased access to health insurance for millions of Americans that allows them to continue essential medical care — which makes the difference, in some cases, between life and death.
The nonpartisan Congressional Budget Office estimates the Senate bill would result in 15 million fewer Americans having health insurance in 2018, compared to 14 million under the American Health Care Act the House approved last month by a four-vote margin. The Senate’s Better Care Reconciliation Act that was unveiled Thursday mirrors the House bill in many respects, including ending the requirement that insurers cover mental illness and addiction.
However, the Senate measure goes further in reducing federal subsidies for Medicaid, the insurance program that covers 69 million Americans, including about 1.9 million in Massachusetts under the program known as MassHealth. Nationally, the Medicaid program serves about two-thirds of people living in nursing homes.
The Senate bill would end the expansion of Medicaid under Obamacare, and would cap federal subsidies so states would not be reimbursed based on actual spending. That would force states to either make up the difference or reduce the number of people receiving Medicaid benefits.
Obama posted a statement on Facebook Thursday critical of the Senate proposal, in which, he said, “I hope our Senators ask themselves — what will happen to the Americans grappling with opioid addiction who suddenly lose their coverage? What will happen to pregnant mothers, children with disabilities, poor adults and seniors who need long-term care once they can no longer count on Medicaid?”
Republican Gov. Charlie Baker also criticized the Senate measure. A spokeswoman said in a statement, “Gov. Baker will keep working with other governors, the Congressional delegation, and federal officials to advocate for solutions that work for Massachusetts, including protecting our waiver to support behavioral health and fighting the opioid epidemic and funding for Planned Parenthood.”
Medical groups also oppose the Senate legislation. According to the American Hospital Association: “The Senate proposal would likely trigger deep cuts to the Medicaid program that covers millions of Americans with chronic conditions such as cancer, along with the elderly and individuals with disabilities who need long-term services and support. Medicaid cuts of this magnitude are unsustainable and will increase costs to individuals with private insurance. We urge the Senate to go back to the drawing board and develop legislation that continues to provide coverage to all Americans who currently have it.”
Senate Majority Leader Mitch McConnell of Kentucky is pushing for a vote this week on the health care bill, before Congress leaves for the Fourth of July recess. Because no Democrats will support the proposal, McConnell needs approval by at least 50 of the Senate’s 52 GOP members to guarantee its passage. Prospects are uncertain because four conservative Republican senators immediately announced their opposition to the measure, saying it does not go far enough in repealing Obamacare and lowering health care costs.
Changes could be made to answer the objections by those conservatives. However, Senate leaders will not be able to appease both them and more moderate Republicans who object to severe cuts in Medicaid. Among those moderates is Susan Collins of Maine who said Sunday she has “serious concerns” about the legislation’s impact on elderly people with chronic illnesses, low-income people, rural hospitals and nursing homes. She was awaiting the CBO report before announcing how she will vote.
It is time for more moderate Republicans like Collins to step up and say that approval of such draconian measures under the arbitrary pressure of an upcoming holiday is no way to craft legislation that affects access by millions of Americans to health care.