On Monday, House Republican leadership released legislation to repeal and replace major provisions of the Affordable Care Act (ACA). The major provisions of the legislation follow an earlier version of the Republican leadership plan leaked in February. WSHA has a draft analysis of the impact to Washington State. The proposed legislation fundamentally changes how insurance is funded through Medicaid and the insurance exchanges.
WSHA’s Position: WSHA’s top priority in the debate about the ACA is to preserve coverage expansions and ensure access to health insurance and care for our residents (see our webpage for more on the WSHA position and principles). If the ACA is replaced, we want to ensure the coverage levels are as good or better than under the ACA. Although there is still budget analysis to be done at the federal level to help complete this picture, it’s already clear that there will be significant reductions in the coverage gains through the ACA.
However, it’s clear that the new proposal is designed to limit access to health coverage, especially for low-income residents. The impact on our residents and our hospitals is too great, and we cannot support the proposal at this time.
The American Hospital Association has also come out strongly against this legislation.
Our draft analysis provides details on the proposed legislation. A summary is as follows:
- Starting in 2020, cuts to the Medicaid program would effectively phase out the Medicaid expansion, forcing states to cut people off their health insurance or to come up with the funding themselves. In Washington, that would mean coming up with $1.2 billion a year. States would be reimbursed at the enhanced federal matching rate (90%) for expansion-eligible people enrolled as of December 31, 2019. After that, new enrollees or changes to enrollment for those with coverage prior to 2020 would be paid at the existing federal matching rate of 50%.
- Repeals the insurance mandates and changes subsidies for coverage for low-income residents to purchase health insurance. The legislation would repeal the individual and employer insurance mandates and authorize refundable tax credits to encourage individuals to purchase coverage. These would be age-based rather than income-based as under the ACA. Health savings accounts would be authorized to help people pay medical expenses, and high-risk pools would be used for people with pre-existing and expensive medical conditions.
- Rigid Medicaid funding would likely hurt Washington even more in the long run. The new bill would limit federal Medicaid payments to states at a per capita amount. The proposal converts Medicaid to a per-capita cap program that would be set using 2016 spending in the state as the base year, trending forward at the medical Consumer Price Index. This may not be sufficient to meet Washington’s needs.
- A small portion of ACA cuts to hospital payments would be reversed, but the majority would still be in place. We believe this is not enough to make up for the losses of coverage. The bill would roll back Medicaid Disproportionate Share Hospital cuts but keep the majority (about 90%) of the Medicare payment cuts contained in the ACA.
We all want a better, more efficient health care system, but we cannot get there as a country without most everyone having access to health insurance coverage. Without coverage, there is no access to care, and without access to care, people cannot take control of their health. Without ongoing access to care, the reliance on emergency rooms will continue, driving up costs for everyone and leaving our communities sicker than before.
WSHA members, staff and lobbyists are hard at work on this issue, and we will continue to be.
The House Energy and Commerce Committee, on which Washington State’s Rep. McMorris Rodgers serves, as well as the Ways and Means Committee, on which Reps. Reichert and DelBene serve, will begin marking up the bill today (March 8). We are also waiting for the Congressional Budget Office, which hasn’t released estimates of the total coverage numbers from this plan, but we expect to see significant reductions in the coverage gains through the ACA.
Once a bill passes the House, the Senate will take up the issue. Leaders have said they most likely will bypass committees and bring the bill straight to the floor. Lawmakers hope to have a bill to the White House by April 7, the start of the congressional Easter recess.
There is more to learn and talk about, so please join us for a webcast on Thursday for the latest news and a conversation about what the GOP proposal means for our patients, our hospitals and our communities.
Thursday, March 9, 2017
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This webcast will be recorded and made available to the public as soon as possible after the webcast.
WSHA is continuing to analyze the impacts on hospitals and working with the American Hospital Association in response to this legislation. Once we have a more complete picture, we will be asking hospitals to weigh in on the impacts of these changes. If you have questions, please contact Chelene Whiteaker, Policy Director for Member Advocacy, at 206-216-2545 or Chris Bandoli, Senior Vice President of Advocacy and Government Affairs, at 206-216-2506.