Health Groups Denounce G.O.P Bills as Backers Scramble

March 11, 2017
Abby Goodnaugh, Robert Pear and Thomas Kaplan
New York Times
March 8, 2017


Representative Kevin Brady, center, Republican of Texas and chairman of the House Ways and Means Committee, arrived for the drafting of a new health care plan on Wednesday. Credit Stephen Crowley/The New York Times

WASHINGTON — Influential groups representing hospitals and nurses came out on Wednesday against a Republican bill to repeal and replace the Affordable Care Act, joining doctors and the retirees’ lobby to warn that it would lead to a rise in the uninsured.

In a letter to lawmakers, major hospital groups wrote, “As organizations that take care of every individual who walks through our doors, both due to our mission and our obligations under federal law, we are committed to ensuring health care coverage is available and affordable for all.”

The groups, including the American Hospital Association, the Association of American Medical Colleges, the Catholic Health Association of the United States and the Children’s Hospital Association, said they could not support the bill “as currently written.”

The hospitals and the American Nurses Association joined the American Medical Association and AARP, which rejected the bill on Tuesday.

House Republicans have been left scrambling to marshal support from businesses and other interests that stand to benefit from lower taxes if the bill passes. Insurers are on the fence, and other powerful forces like pharmaceutical companies remain largely on the sidelines.

Squeezed between wary health care providers and angry conservatives who believe that the bill leaves too much of the Affordable Care Act in place, the Republican leadership and President Trump appear to be facing an uphill climb.

But the White House appears increasingly confident about the prospects for a health care overhaul to pass in the House. In a meeting with conservative leaders in the Oval Office on Wednesday, Mr. Trump said he anticipated the most trouble in the Senate, where moderate and conservative lawmakers are opposing the plan for different reasons. He said he was prepared to pressure holdout senators by holding the kind of stadium-style rallies he led during his presidential campaign.

The House speaker, Paul D. Ryan, said Republicans were “going through the inevitable growing pains of being an opposition party to becoming a governing party.”

“It’s a new system for people,” he added. “But it’s all the more reason why we have to do what we said we would do and deliver for the American people, and govern and use our principles.”

The array of groups taking strong positions against the bill is evidence that its potential consequences extend far beyond health insurance coverage, to much of the nation’s economy.

The opposition is also a powerful reminder of how many past efforts to overhaul the American health care system failed because of resistance by major interest groups. Winning the support of the health care and insurance industries allowed the Obama administration in 2010 to push through the most significant health care legislation since President Lyndon B. Johnson’s Great Society.

Within a few months after President Barack Obama took office in 2009, his administration had lined up support from health care providers, insurers, consumers and pharmaceutical makers by offering a grand bargain: The health bill would include a requirement that most Americans have health insurance, providing millions of new customers through the law’s often substantial premium subsidies and its option for states to expand Medicaid. In exchange, hospitals would have to accept spending cuts and the health care industry would have to accept new taxes to pay for the legislation.

The Obama White House dedicated enormous effort to win pledges of support before Democrats even put out a bill — an effort not replicated by the Trump White House or Republican leaders in Congress.

But the Affordable Care Act also created an array of taxes that the Republicans now hope to wipe away, helping them win the support of groups like the U.S. Chamber of Commerce and Americans for Tax Reform, led by the anti-tax activist Grover Norquist.

The congressional Joint Committee on Taxation issued estimates this week showing how much revenue the government could lose starting in 2018 under the Republican bill, which the party has called the American Health Care Act, as a result of repealing taxes on drug makers (nearly $25 billion over 10 years), insurers (nearly $145 billion), makers of medical devices (nearly $20 billion), and high-income households (more than $270 billion from taxes on earned income and investment income).

“The American Health Care Act repeals the medical device tax, which will result in greater investments in medical cures, lower health care costs and more high-tech manufacturing jobs in communities across the United States,” trumpeted the Medical Device Manufacturers Association.

The extent to which these groups mobilize on behalf of the Republican bill may help determine whether it succeeds.

For now, the supporters of the House bill seem badly outgunned by opponents. On Wednesday, as two congressional committees took up the Republican repeal-and-replace bill, the American Nurses Association and a coalition of hospital groups came out against the proposal.

The A.M.A., which has nearly 235,000 members and calls itself the voice of the medical profession, sent a letter to leaders of the two committees on Tuesday saying it could not support the Republican bill “because of the expected decline in health insurance coverage and the potential harm it would cause to vulnerable patient populations.”

In particular, the group said it opposed a plan to replace the sliding, income-based premium tax credits provided under the Affordable Care Act with fixed credits based on age. The current system, it said, “provides the greatest chance that those of the least means are able to purchase coverage.”

America’s Health Insurance Plans, the health insurance lobby, released its own lengthy statement on Wednesday. In a letter to the leaders of the House committees that drafted the bill, Marilyn B. Tavenner, the group’s chief executive, warned Republican leaders that their plans to change Medicaid financing, among other things, could harm coverage and care.

While many insurers have lost money in the Affordable Care Act’s private insurance marketplaces, they have generally profited from the expansion of Medicaid, which would effectively be phased out under the Republican plan.

“As a core principle, we believe that Medicaid funding should be adequate to meet the health care needs of beneficiaries,” Ms. Tavenner wrote. “Medicaid health plans are at the forefront of providing coverage for and access to behavioral health services and treatment for opioid use disorders, and insufficient funding could jeopardize the progress being made on these important public health fronts.”

A day earlier, AARP — the association of middle-aged and older Americans that is another crucial supporter of the Affordable Care Act — declared its opposition to the bill and even started running an ad against it. In a letter to Congress, the group said the bill would increase health costs for people ages 50 to 64, could lead to cuts in Medicaid coverage of long-term care and would allow insurers to charge older people five times as much as younger ones.

The hardening resistance complicated the case for the Republicans as they moved their bill forward on Wednesday.

“I respect those organizations and their views,” said Representative Larry Bucshon, an Indiana Republican and a heart surgeon who conceded that criticism of the bill from doctors and hospitals could make it more difficult to sell the measure to the public. “Their voice is an important voice in health care.”

But, he noted, those groups supported the health care law in 2010.

“Hospitals have done quite well under the Affordable Care Act, but my constituents have not,” he said. “Their premiums are going up. Their deductibles are high.”

Across the rotunda, Republican senators were less enthusiastic.

Senator Shelley Moore Capito, Republican of West Virginia, said she was not certain that a delay in the rollback of Medicaid coverage was “enough for me.” Senator Lisa Murkowski, Republican of Alaska, expressed alarm that the bill’s tax credits would not account for higher premium costs in insurance markets like hers, a largely rural state with little competition. Senator Marco Rubio, Republican of Florida, said he did not want states that took the Medicaid expansion to “get a benefit” that the states that rejected the program did not.

Senator Susan Collins, Republican of Maine, said she was unhappy that the bill removed money for Planned Parenthood.

There was also a creeping concern about how quickly the bill was moving. Senator Mitch McConnell of Kentucky, the Republican leader, essentially promised to move the bill to the Senate floor without the hearings and other processes that are normal for such a far-reaching piece of legislation. He had promised when Republicans took the majority that they would honor normal Senate processes and traditions.

“I think if that’s the approach they take,” Mr. Rubio said, “they won’t have the votes in the Senate.”

Jennifer Steinhauer, Emmarie Huetteman and Jeremy W. Peters contributed reporting from Washington, and Reed Abelson from New York.



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