Hospitals remain opposed to Senate healthcare bill; AMA sees slight improvement

Whenever Republicans in the House or Senate have released a new version of an Affordable Care Act (ACA) replacement plan in 2017, healthcare industry reaction has been almost uniformly negative. The same can largely be said for the newest version of the Better Care Reconciliation Act (BCRA).

The American Medical Association (AMA) continues to oppose the legislation, noting the revised bill still eliminates Medicaid expansion and will result in millions losing insurance coverage. But the organization notes small improvements in providing extra funds to fight opioid abuse and assist the individual market.

“The additional funding to address the opioid epidemic is a positive step, however, those suffering from substance use disorder have other healthcare needs that are not likely to be addressed if they lose coverage through a rollback of the Medicaid expansion,” said AMA President David Barbe, MD, MHA, in a statement. “While stabilizing the individual market is an initial step, more bipartisan collaboration is needed in the months ahead to improve the delivery and financing of healthcare.”

Supporters of the bill won’t find any kinder words from other industry groups. The American Hospital Association said the “unacceptable flaws of BCRA remain unchanged.” The Association of American Medical Colleges said it would “put added financial pressure on state budgets and healthcare providers.” The American Congress of Obstetricians and Gynecologists (ACOG), which has opposed BCRA efforts because maternity care would likely be excluded from coverage if the ACA’s required benefits provisions are waived, said the bill “cannot be fixed and keeps getting worse.”

The brunt of the negative comments focused on new provisions championed by Sen. Ted Cruz, R-Texas. Under his proposal, insurers would be able to offer plans which don’t offer the ACA’s required benefits and can charge higher premiums based on health status, as long as they also offer at least one ACA-compliant plan in the same state. Insurers have warned this would split the individual market’s risk pool, pushing sicker patients into the more comprehensive plans, resulting in much higher premiums for those with pre-existing conditions and destabilizing the market.

“As a health insurance CEO, this is not an option that we want or need,” said Andrew Dreyfuss, president and CEO of Blue Cross Blue Shield of Massachusetts.

The provision was designed to attract more support from conservatives who felt the original bill left too much of the ACA in place. Sen. Rand Paul, R-Kentucky, however, has already said he’ll vote against a motion to proceed to a vote on the bill. Among moderate Republicans, Maine Sen. Susan Collins has also said she’ll vote against the motion. One more defection would kill the bill. According to POLITICO, at least seven senators remain undecided.

“I did not support the Senate's first draft. Now, I will review the new draft legislation and want to see the CBO score and additional analysis of the legislation. I will reserve judgment until we do so,” said Sen. John Hoeven, R-North Dakota, one of the undecided votes.

Some new provisions were designed specifically for those senators, like Alaska’s Lisa Murkowski, whose state would receive an additional $750 million over 10 years, according to Bloomberg. Putting additional pressure on those wavering senators will be support from conservative groups. FreedomWorks called the Cruz provision and allowing health savings accounts to pay for premiums “a step in the right direction.”

Among healthcare groups, however, the preferred strategy seems to be scrapping the bill altogether and involving both parties in crafting new legislation.

“The BCRA—even with modifications—will not preserve and improve essential coverage, benefits and consumer protections, and access to care for both currently insured and uninsured individuals, children and families,” wrote American College of Physicians President Jack Ende, MD, in a letter to Senate leaders. “Therefore, we strongly urge that the Senate move away from the fundamentally flawed and harmful policies that would result from the BCRA.”