After a grueling 27-hour debate, the U.S. House Energy and Commerce Committee, chaired by Oregon’s Rep. Greg Walden, voted March 9 to advance the GOP health care plan. The vote was party-line, with the Republican Walden praising the bill for its “affordable, patient-centered reforms,” with “greater flexibility, lower costs for families and greater choice for patients.”
His fellow representative from Oregon, Democrat Rep. Kurt Schrader, was also in that marathon committee meeting, and his description of the American Health Care Act was less flattering.
“Misguided,” “backward” and even “dark ages” are the words he used to describe the proposal Republicans served up to replace the 2010 Affordable Care Act.
The GOP’s proposal would have repealed the individual mandate/tax penalty incentive for having minimum insurance coverage and capped the amount of Medicaid funding provided to states annually. It jeopardized already fragile funding for mental health care and directly cut women’s health services. And it would have repealed funding for the Prevention and Public Health Fund, among many other changes.
The nonpartisan Congressional Budget Office reported that the plan, as proposed, would result in 24 million more people without insurance by 2020 than under the current plan. The House Republicans insisted on voting the proposal out of the committee before the CBO released its report.
But even with Republicans in control of the White House, the House and the Senate, as of Friday, March 24, the GOP plan failed to garner enough support to come to a vote. The bill was pulled for reconsideration. Schrader said he and others have been leading the charge to re-craft the proposal to fix existing problems inherent within the current Affordable Care Act, but not to gut the system, as some GOP members have suggested they do.
“We have a lot of options left to showcase what is wrong with this thing and why it undermines the fabric of our country just when we thought we were starting to be a country where health care was a right and not a privilege,” Schrader said.
At recent town hall meetings and online, Schrader has asked people who are worried about health care and other issues to tell him their story. Speaking to him before the health care bill died in the House, we asked what he was hearing.
Kurt Schrader: I had a constituent the other day whose baby was determined to have some developmental issues before he was born, and he would never have had health care, they would never have been able to get this child covered, and thanks to the Affordable Care Act, their son is doing very, very well. He’s coming along and getting the treatment and the therapy that he needs. And he would never have had that.
There are tons of issues, the cancer treatments that would have been totally unaffordable, the diabetic management issues that people wouldn’t have had, or gotten the right counseling for.
In Oregon, as a result of the Medicaid expansion in particular, coordinated care organizations are actually able to put some money aside to take care of some of the social determinants that lead to bad health. In other words, they’re able to follow up with their patients and make sure they’re taking their medication, either by phone or going to their home. They’re able to make sure their patients can go to the grocery store, that they see their doctor. And frankly, in some cases, make sure that there’s housing for some of the very-low-income people. Because, as we all know, you can have all the greatest treatment in the world, but when you’re just trying to put a roof over your head, all the other stuff pales in comparison and just falls by the wayside. So it’s been a lifeline for a lot of folks.
FURTHER READING: What's next for Oregon Health Plan?
Joanne Zuhl: And people are telling you they’re worried about the GOP proposal if that went through?
K.S.: Oh yeah. I have people who are terrified. Just absolutely terrified. We’ve had some huge town halls, a thousand people in Salem, 600-plus in Milwaukie, a few hundred in Woodburn, and they’re all terrified of losing this access. The stories and the fear – the fear is palpable. Between that and the immigration issue, those two issues are striking fear and unrest, if you will, in a lot of Americans who shouldn’t have to feel that way. It’s sad this current administration is sowing that, and frankly, my Republican colleagues are sowing that type of fear and distrust.
J.Z.: Speaking of colleagues, your colleague from across the aisle, Congressman Greg Walden, is chairman of the House Energy and Commerce Committee and represents the district in Oregon that analysts say could be among the hardest hit by the repeal of the ACA. Walden’s district added more new Medicaid recipients under the ACA than any of the other congressional districts in GOP control. What do you say to him, and what do you talk about?
K.S.: Well, I try not to poke my good friend and colleague in the eye. I’m sure Greg’s very aware that 45 percent of his folks are on Medicaid. Poor, low-income folks are not an attribute of urban areas only. Rural America has a huge poverty issue, and frankly it’s been tough to earn a living in rural America these days. So they end up falling into the safety net system – it’s a lifeline for those folks. I’d like to think that Greg is probably one of the reasons the Medicaid proposal is not just a flat block grant. There is some nod toward caseload and some toward inflation. It penalizes our own state, ironically, but at least there’s a nod in that direction. I worry – hopefully, it won’t be as bad as people say it is, but the CBO report was pretty devastating.
My read on it is we go all the way back to the way it was pre-Affordable Care Act, where instead of 24 million that have coverage, 24 million don’t have coverage. There’s no money to do anything but acute care treatment. We go back to big uncompensated care budgets. You see where the Republication put a huge DSH (Medicaid’s Disproportionate Share Hospital) payments back in. Yeah, if you’re not going to cover people and you want to help the providers out a little, but it’s the exact wrong way to go. It’s going back, unfortunately, over what we’ve done over these last eight years.
Note: Medicaid DSH allotment reductions were put in place under the ACA to offset the reduced costs to safety net providers after more individuals gained insurance. The GOP’s plan to increase DSH funding in the AHCA reverts back to offsetting the cost to safety net providers’ serving more people who are uninsured.
I think it’s important to remind people that we had a serious problem with runaway premium inflation and deductible increases before the Affordable Care Act. That was the reason we did this. It was a bipartisan, universal agreement – we needed to do something about the runaway prices in health care, given the advances in medicine and the costs therein and the fact that baby boomers were retiring. I think people forget in a short period of time what the system was like, just eight years ago, when the system was inflating through the roof. Unfortunately, the Republican budget puts us back in that same area.
J.Z.: You could also argue that it takes us further back. The proposal would defund Planned Parenthood by cutting off Medicaid reimbursements. For many low-income women, Planned Parenthood is their primary caregiver. This means birth control, diabetes and cancer screenings, and reproductive health care will become less accessible to many women in poverty, particularly in rural areas. What are women to make of that attitude toward their wellbeing?
K.S.: Well, I think the president was pretty clear in his campaign: He doesn’t care about women. He’s very misogynistic, and unfortunately, my Republican colleagues from these extreme right-wing pro-life states have decided that the Hyde Amendment – which was a good balance, I thought, a fair balance, recognizing the diversity of views in our country – is not good enough, and they’re just going to prevent women from getting the preventive health services that they’ve enjoyed for the last 20 or 30 years. That’s sad. This is truly pushing the clock to the dark ages, where we’re burying our heads in the sand about what’s going on.
And frankly, for my Republican colleagues, they don’t want to legislate all this stuff back home: states’ rights and all that. But they’re fine about legislating in the bedroom, which I think is just disgusting and reprehensible, taking advantage of this thing and turning that clock back. It’s very, very sad.
Note: The Hyde Amendment, named for Rep. Henry Hyde (R-Ill.) prevents the federal funding of abortions through Medicaid except to save the life of the woman or if the pregnancy is the result of incest or rape. It was originally passed in 1976 and is required to be voted upon for renewal with each budget. This year, a proposal to make it permanent, and also ban federal funds for insurance coverage for abortions, passed the House.
J.Z.: Another proposal that’s gotten a lot of attention is the anticipated cuts to addiction treatment and the effect that could have on efforts to stem the nationwide opioid epidemic. There have been considerable efforts made to address it, certainly in Oregon, as both a health care and addiction problem. It sounds like with this plan, that’s all in jeopardy.
K.S.: I think very definitely, the opioid epidemic, mental health treatment in general is in jeopardy as a result of this misguided Republican repeal agenda. It goes exactly against what we tried to accomplish just last year in our rewrite of the mental health laws. We addressed the opioid epidemic last year. We tried to put more money into the treatment and prevention that a lot of the advocates have asked us for. That was a nice bipartisan bill.
By taking out the requirement that mental health be included in the essential benefits package for low-income people in particular is going to mean that a lot of states that can’t afford to pick up the tab as the federal government cuts the reimbursement are going to say we can’t afford to do mental health, we can’t afford to do dental health, or behavioral health. And all of that stuff will go by the wayside and undermine the exact work we tried to accomplish last year.
It’s penny-wise and pound foolish, and I don’t think they understand – well, I guess they do. Let’s be honest, what I heard all through the hearings was we’re worried about flexibility, we’re worried about market forces; there was not a single comment about making sure our most vulnerable people got health care. And that’s what it’s supposed to be about, health care, right?
J.Z.: I want to ask you about the 27-hour meeting.
K.S.: It was a long, bloody 27 hours.
J.Z.: Did anything move? Was there any progress?
K.S.: None of the amendments were accepted. I think some of the points were made. I was surprised at the relative cogency of the discussion. Even at hours 24, 25, 26, members were still making good points. I was actually a little impressed that at 4:30 in the morning, I got a little play on an idea I had on how to deal with the Medicaid reimbursement going forward. People were paying attention. But it’s unfortunate they wouldn’t take any of our actual fixes.
Because that’s what’s really needed. The individual market is in real trouble. Everyone acknowledges that’s 5 percent of health care delivery in the country, and a small part of the ACA gets some outsized recognition for what it is. And in that individual market, half the people in there just feel lucky as hell they got health care at any price because they could never get health care before.
There are some problems for people who aren’t on subsidies, in terms of premiums and deductibles – so let’s fix that. Let’s not throw the whole thing out. That’s dumb, and we’re going back to the dark ages.
Email Managing Editor Joanne Zuhl at email@example.com.