Opposition forces GOP senators to delay ACA repeal-and-replace vote


Photo by Sean Stayte via flickr.

Senate GOP leaders today scrapped this week’s planned vote on their version of Obamacare repeal-and-replace legislation, with plans for a quick turnaround on the bill faltering in the face of fierce opposition from voters and a wide variety of interest groups.

After the Congressional Budget Office reported Monday that the Better Care Reconciliation Act would cause 22 million Americans to lose their health insurance, organizations representing physicians, hospitals, small businesses and Medicare patients and other interest groups said the BRCA would have a devastating effect on the health insurance system.

John Arensmeyer, chief executive and founder of Small Business Majority, said the bill would harm small businesses by destabilizing the health insurance market, causing premiums to rise sharply and leaving millions of entrepreneurs and small business employees unable to afford coverage. An expert on health insurance and small businesses, Arensmeyer, whose group represents 55,000 small businesses, spoke at Health Journalism 2014 in Denver.

The BRCA is the Senate version of the American Health Care Act passed by the House last month. While both bills’ stated aim is to make health coverage more available and affordable for Americans, Tara Golshan at Vox reported that opponents so far were making a convincing case that the BRCA was more designed to create room in the federal budget for tax cuts for the wealthy.

According to the CBO analysis, the BRCA would raise the number of Americans without health insurance by 22 million by 2026, wrote Thomas Kaplan and Robert Pear for The New York Times, only slightly less than the 23 million expected to lose coverage under the AHCA.

“Next year, 15 million more people would be uninsured compared with current law, the budget office said,” Pear and Kaplan reported.

The CBO report also shows that the bill would cut federal deficits by $321 billion over 10 years (from 2017 through 2016). This estimate is $202 billion more than the estimated net savings the CBO estimated for the AHCA.

In Forbes, Bruce Japsen quoted a letter from the American Medical Association (PDF) to Senate Majority Leader Mitch McConnell (R-Ky.): “Medicine has long operated under the precept of Primum non nocere, or ‘first, do no harm.’ The draft legislation violates that standard on many levels.”

The American Hospital Association urged its members to write to members of the U.S. Senate to ensure that continued health care coverage for the millions of Americans who have benefited from the ACA. “Patients and the caregivers who serve them are depending on legislators to make continued coverage a priority,” the AHA said.

The National Rural Health Association issued a statement (PDF) saying that “The Better Care Reconciliation Act will hurt vulnerable populations in rural Americans, leaving millions of the sickest, most underserved populations in our nation without coverage, and further escalating the rural hospital closure crisis.”

In a particularly strong statement, the Medicare Rights Center called the BRCA “heartless.” The Senate bill would cut $772 billion from Medicaid over 10 years, the center said, adding that such a deep cut would, “end the program as we know it.” Such a decrease in funding would put access to home and community-based services, nursing home care, and other services at risk for 11 million older adults and people with disabilities who are in Medicare and on Medicaid. Those who use both programs are known as dual-eligibles, as my colleague Liz Seegert has reported.

“As our nation grows older and becomes increasingly reliant on Medicaid, cuts of this magnitude can only be described as heartless,” the center said.

At Vox, Sarah Kliff highlighted what the CBO report showed would be the effect of the BRCA on low- and middle-income Americans. The report showed that “low-income Americans would be asked to pay higher premiums for worse health insurance coverage,” she wrote, highlighting the CBO’s explanation on page 48 of the 49-page report.

In The New Yorker, Atul Gawande, M.D., explains the importance of “incremental” care as opposed to emergency care and how health insurance plays into that.

Earlier coverage:

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Joseph Burns

Joseph Burns is AHCJ’s health beat leader for health policy. He’s an independent journalist based in Brewster, Mass., who has covered health care, health policy and the business of care since 1991.