In a letter to House Republicans, Richard Pollack, AHA’s president and CEO, asked Congress “to protect our patients, and find ways to maintain coverage for as many Americans as possible. We look forward to continuing to work with the Congress and the Administration on [Affordable Care Act] ACA reform, but we cannot support The American Health Care Act in its current form.”
Pollack also came out against a provision of the legislation that would strike funding for states to expand Medicaid beyond 2019. Hospitals, he continued, would be adversely affected by elements of the measure that give relief to other industries largely through eliminating taxes imposed by Obamacare yet offer no help for them. For example, items like the overall tax on healthcare plans have been removed entirely, but a reduction in Medicare payment levels for hospital services remains in place.
“If coverage is not maintained at the current level, those resources need to be returned to hospitals and health systems in order to provide services to what will likely be an increased number of uninsured Americans,” Pollack said.
The GOP’s proposal would also shift Medicaid’s “per capita cap” from a system where the federal government pays for the entirety of an enrollee’s medical bills to one in which states would receive a set amount per Medicaid enrollee. The problem, Pollack notes, is that Medicare already doesn’t provide enough funds to cover the actual cost of providing care. A greater use of federally approved waivers could mitigate the damage, he said, and give states a method to test out different ways to implement Medicaid which would maintain the program’s integrity but not follow federal rules.
“The expanded use of waivers with appropriate safeguards can be very effective in allowing state flexibility to foster creative approaches and can improve the program more effectively than through imposing per-capita caps,” he said.
Pollack recommended Congress wait for the Congressional Budget Office (CBO) to score and release estimates on how many individuals the measure would cover before moving it forward. Early estimates have not been kind to the Republican plan, with one analysis concluding that as many as 10 million people could lose their coverage. A CBO score would provide a “level of analysis and needed transparency,” Pollack wrote, and provide vital information regarding the legislation’s impact “on both individuals and the ability of hospitals and health systems which are the backbone of the nation’s health care safety net in terms of our ability to care for all of those who walk through our doors.”
AARP (formerly the American Association for Retired Persons) has also come out against the American Health Care Act, citing a provision which would allow insurers to raise premiums for older Americans to rates five times higher than they charge younger workers provided state regulations allow it. Obamacare had successfully capped this ratio, known as the “age rating,” at 3 to 1.