Before U.S. Senate Majority Leader Mitch McConnell unveiled a rewrite of the Republicans' health care bill on Thursday, Georgia hospitals, patient advocates and budget hawks had strong feelings about the bill.
They still do. And they haven’t changed much.
For rural hospitals, the latest revision of the effort to repeal and replace Obamacare is just rearranging the deck chairs on the Titanic, an advocate said; one for patient care called it destabilizing. A signal issue for them remained the fundamental scaling back of Medicaid that the Senate Republicans would do.
But for taxpayers and insurance customers, it’s an even better step toward consumer choice and market efficiency, said Kelly McCutchen of the libertarian-leaning Georgia Public Policy Foundation.
Georgia U.S. Sen. Johnny Isakson, with backing from his colleague David Perdue, scored a bargaining win with a funding formula for indigent care hospitals that is now included in the newest bill. The formula will now be more friendly to states such as Georgia that didn’t expand Medicaid. And the amendment in the bill to ease requirements on what plans insurance companies can sell is a longtime conservative goal.
For Georgia’s conservative supporters of the bill, that’s some of the biggest news out of Thursday’s unveiling. The provision that could unchain insurance companies from requirements to provide certain levels of insurance, known as the Cruz Amendment, undoes a central tenet of Obamacare and was suggested by Texas U.S. Sen. Ted Cruz. If it’s done by allowing states to choose to waive the requirements, Georgia’s Republican leaders are likely to be interested.
But a slew of patient and health care provider advocates were distressed.
Before the unveiling, 50 organizations including Mercy Care, which deals with the poor, and some liberal organizations together wrote Isakson that the patients they represent “stand to lose critical access to healthcare.” Their concerns didn’t diminish following the unveiling, said Cindy Zeldin of Georgians for a Healthy Future, one of those groups.
“This legislation still raises red flags for consumers: the deep cuts to Medicaid, weakening of consumer protections, and destabilizing of insurance markets would diminish coverage, access, and affordability for Georgians,” Zeldin said in an email.
The Georgia Hospital Association tipped its hat to the senators for nudging formulas more to state hospitals’ benefit. But the hospitals “continue to have serious concerns regarding the Medicaid cuts and the increase in the number of uninsured patients,” said Earl Rogers, the association’s president.
Georgia’s play
The bill did improve for Georgia, Republican leaders point out.
Of high concern for Isakson, Perdue and Gov. Nathan Deal in recent months has been ensuring that Georgia, which did not expand Medicaid under the Affordable Care Act, was not at a significant disadvantage in the Senate bill compared with the 31 states that did.
Isakson aimed to do that in part by securing more money for charity hospitals such as Grady Memorial Hospital, which take on a greater share of uninsured patients. After the first Senate GOP bill screeched to a halt, Isakson asked McConnell to change the way Medicaid funds Grady and other safety-net hospitals through its Disproportionate Share Hospitals program.
Isakson said he felt like some of his concerns were addressed in the new Senate bill.
“I worked hard to see that the distribution formula was more equitable for” those hospitals, Isakson told reporters Thursday. The new bill “is going to make the formula of reimbursement to disproportionate share hospitals more equitable than it would have been under the Affordable Care Act. And I think hospitals like Grady and others will feel like it’s a much fairer treatment.”
Perdue told Bloomberg Television that he does like the bill but he qualified that, saying: “This thing continues to evolve. But I think we’re getting to a point now where we’re very, very close.”
The Senate negotiations over the past weeks have been largely geared to building a coalition of 50 votes; GOP leaders cannot afford to lose more than two Republicans, and it looks as if they've already lost two.
That has put them in something of a “damned if we do, damned if we don’t” situation, Perdue told reporters Tuesday.
“If you fix it, then nobody is going to be 100 percent happy with what you do,” Perdue said. “If you don’t fix it, then it’s your fault. The problem is that we didn’t create it. There are some people in our caucus in the Senate who believe we ought to just sit back and let it collapse. I think that’s irresponsible, but I’m just one person.”
Opioids and HSAs
McCutchen also gave props to Republicans for a tax cut that would go to health savings accounts, or HSAs, and allowing premiums to be paid from the accounts.
“We need to get insurance back to catastrophic care the way it’s supposed to be and let people pay directly,” McCutchen said. “HSAs is a way to do that.”
Monty Veazey, who heads an organization for community hospitals often in rural areas, scoffed. “HSAs do not help people with no money,” he said.
He added that the amendment suggested by Cruz, which could allow insurance companies to sell catastrophic plans, “does nothing to help the people who are in need the most.”
Another issue getting airtime in Georgia is opioid funding.
Senate Democrats said the money was just a gesture, not a solution. “This puts a Band-Aid on a gaping wound that is the opioid epidemic,” said U.S. Sen. Ron Wyden, a Democrat from Oregon.
But state Sen. Renee Unterman, a Republican from Buford who has taken up the issue as chairwoman of the state Senate’s health committee, was pleased.
She touted the inclusion of $45 billion over 10 years for opioid addiction treatment, also mentioning the provisions that protected HSAs.
“We are moving the dial,” she said. “I think it’s an improvement.”
She echoed the concerns of Deal and other state officials who said Georgia shouldn’t be penalized in the funding formula for refusing to expand Medicaid.
“We shouldn’t be punished,” she said.
“This is more palatable to conservative Republicans,” she said. “The most important thing that I’m concerned about is the drag on the economy. All this ambiguity — it’s time to fish or cut bait. We need to move on it.”
