Georgians, like the rest of the nation, finally came face to face with the U.S. Senate’s long-hidden health care proposal Thursday. And one way or another, they said, its impact on the state could be profound.
Liberals decried its potential impact on women’s health and care for the poor. After a quick look at the provisions of the Senate version of the American Health Care Act, one expert said it could lead to even more Georgians without health insurance than the 720,000 that could wind up uninsured under the version the U.S. House passed in May.
Or, Georgians shackled for years by mandates for insurance coverage they don’t want would finally be freed, U.S. Sen. David Perdue said. It might even lead more to buy insurance, he said — just insurance that covers less.
“Certainly the access will be much better,” Perdue told a scrum of reporters in Washington as the news broke and the bill was released. He spoke just steps from the U.S. Senate floor, a copy of the bill tucked under his arm. “But it certainly is better than what we got in the House bill. I can live with this.”
Another ring of support came Thursday evening from high quarters. “I am very supportive of the Senate #HealthcareBill,” President Donald Trump tweeted. “Look forward to making it really special! Remember, ObamaCare is dead.”
Deep uncertainty remains not only about the political fortunes of the bill, but about what it would do in any particular area if it were to become law.
Though Senate leaders want a vote next week, it currently lacks the votes to pass, with four conservative senators saying it doesn’t go far enough to undo Obamacare. As to health insurance coverage, it would offer individual states expanded choices, and no one knows now how each state would choose.
The one thing that’s sure is that it would join the House bill in going quite far to scale back programs that have become a mainstay of health care for Americans. Medicaid, the federal health care program for the poor, would see deep cuts and a fundamental restructuring for the first time in a half century. And the mandates that certain companies offer health insurance and that each American have a plan would be wiped away.
The next big announcement should come from the Congressional Budget Office, which plans early next week to score the bill for its impact on the budget and on future numbers of uninsured Americans.
Back in the spring, the CBO predicted that the version the House passed could lead to 23 million more Americans without health insurance. Bill Custer, a professor of business and health administration at Georgia State University, said that boiled down to 720,000 Georgians.
The Senate bill could increase that, Custer said, partly because it scales back Medicaid even more, making it grow not with inflation in health prices but with inflation generally.
The Georgia Hospital Association released a statement brimming with anxiety.
“Georgia hospitals provide more than $1.7 billion in uncompensated care each year,” the association’s president, Earl Rogers, wrote in a statement. He called the Senate version’s cuts to Medicaid “devastating” and said it will leave more Georgians uninsured and underinsured.
“We urge Senators Isakson and Perdue to carefully consider the negative impact the AHCA will have on our hospitals’ ability to care for all patients and their communities,” he concluded.
The Senate bill also would scale back subsidies for buying insurance.
Currently, a family can get subsidies for insurance premiums under the Obamacare exchange if they have a household income that happens to fall somewhere near the Georgia average or below. The Senate bill would lower that ceiling. In addition, it would phase out subsidies for out-of-pocket costs.
Custer cautioned that it was very difficult to analyze the bill with certainty just hours after the bill’s unveiling, and that analysts like him would have to dive deeper.
“The bottom line is, I’m pretty dang certain that there’ll be more uninsured simply beause there’s less money — as I understand the bill right now,” Custer said. “It comes down to a higher cost to consumers.”
The great unknown in this bill is how states will react. For example, the bill proposes to allow states to let insurance companies off the hook for requiring certain essential health benefits in all plans, such as coverage for mental health, maternity care or prescription drugs. And states could choose to take their Medicaid money in different forms.
Backers of the GOP plan point out that the poorest Georgians have been utterly without insurance under Obamacare, since Georgia opted not to expand Medicaid as Obamacare presumed it would. But under the Senate plan, they would now have tax credits to encourage them to buy insurance.
Another analyst, Eric Wright of Georgia State University, said, however, that tax credits are not very effective in prompting the poor to buy things at a discount because their money is so tight to begin with.
Wright said Georgia could wind up with “Swiss cheese” policies that have important holes when people show up at the emergency room. And that, he complained, could drive up costs.
Kelly McCutchen, the president of the libertarian-leaning Georgia Public Policy Foundation, countered that he had yet to dive into the details. But he was pleased with the prospect of more tax credits bringing money into the economy. “There may be pros and cons,” he said. “There might be more money in some things and cutbacks in others.”
The left-leaning Georgia Budget and Policy Institute on Thursday released an analysis of the House bill showing that Children’s Healthcare of Atlanta at Hughes Spalding would be the hospital hardest hit in Georgia by the legislation. The Senate bill only reinforced the study’s findings, said GBPI’s Laura Harker, “with few exceptions.”
“Georgia’s hospitals stand to lose even more from the Medicaid cuts proposed in the U.S. Senate bill released today,” Harker said in a statement.
One high-profile social issue made it into the Senate bill as well, cutting off the support the federal government currently gives for Planned Parenthood’s nonabortion services for women’s health.
“This bill is the worst bill for women in a generation,” Staci Fox, the CEO of Planned Parenthood Southeast, said in a written statement, citing not only that provision but the others cutting aid that goes to lower-income women.
“It would make it harder to prevent unintended pregnancy, harder to have a healthy pregnancy, and harder to raise a family,” Fox said.
Fox added that it would disproportionately hurt women of color, who make up more of Georgia’s population than in most other states.
Georgia Right to Life, a group that generally opposes Planned Parenthood, did not respond to requests for comment.
In the end, it comes down to the Senate’s support. The bill is labeled a “discussion draft” and will likely change. The question is whether it can change enough to get the needed votes. Like House Republican leaders, Senate GOP officials face a sort of whack-a-mole game of trying to keep conservatives on board while not losing moderates — or vice versa.
Georgia’s senior senator, Johnny Isakson, a Republican like Perdue, was less than roaring in his support. But he didn’t throw bombs.
“I want to be supportive of the leadership,” Isakson said.
“I’ve got a lot to learn about what is in the draft because I haven’t seen it yet,” he said. “I’m pleased that it includes pre-existing conditions. I’m pleased that it includes 26-year-olds staying on their parents’ health policy. But there are lots of questions. … But I want to be supportive and I’m going to do everything I can to be supportive of a good bill for Georgia.”
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