As I covered previously, the U.S. House of Representatives on May 4, 2017, recklessly passed the American Health Care Act by a 217-213 vote. They did so with little transparency, thoughtful debate, or meaningful stakeholder input. Crucially, they also passed this bill without even knowing its potential impacts on the ability of Americans to access quality health care services. Based on an analysis of the previous version of the American Health Care Act, however, this bill would likely result in the loss of health care coverage for 24 million Americans, potential restrictions for 15 million Americans with pre-existing conditions, and $800 billion+ in Medicaid funding slashed over ten years.
According to a report released on May 18 by Avalere Health, children would be significantly impacted by the proposed Medicaid changes in the American Health Care Act. Funding for children on Medicaid would be slashed by up to $43 billion over ten years under a per capita cap plan, while it would be slashed by up to$78 billion under a block grant plan (read more about block grants here). While Medicaid is often discussed in terms of an entitlement and with a particular focus on the controversial Medicaid expansion, its impact on children’s health care does not receive nearly as much attention. Children represent the largest group of enrollees covered by Medicaid, and the program covers nearly half of all births in the United States. Medicaid provides crucial health care services to children and, under Early and Periodic, Screening, Diagnostic, and Treatment (EPSDT) requirements, these children cannot be denied necessary care. This health care (or lack of) impacts the health of the child for the rest of his or her life; a healthy child is more likely to grow into a healthy adult.
As we wait for the American Health Care Act to move to the U.S. Senate for consideration, the American Nurses Association encourages all 100 senators to consider the stakes of this bill for the health of our nation’s children. Access to quality health care for children not only ensures that they are healthy in the here and now, but also ensures that we are raising a healthy and productive generation of Americans who are able to lead productive lives to the best of their abilities. ANA also urges the Senate to reject the flawed American Health Care Act – which flies in the face of our stated health care reform principles – and to undertake a deliberative, thoughtful, and transparent process which produces a piece of legislation which ensures quality health care access to all Americans.
For more information on the latest from ANA’s Capitol Hill efforts, continue to follow us on our RNAction page and ANA’s Capitol Beat.
Last week, Michele Woodward, a prominent Republican and former White House staffer in the Reagan Administration, posted a powerful critique of the Republican health care reform bill known as the American Health Care Act. Ms. Woodward noted of the legislation that:
You see, the health care bill passed in the House today has nothing to do with making sure all Americans have access to healthcare. The GOP leadership didn’t go in saying, “How can we raise the standard of living for all Americans by insuring their health?” No, they did not. Instead, they said, “How much money can we take out of this program?” Why? Because taking money from Obamacare allows the tax cuts the GOP really wants. Tax cuts that mostly benefit the wealthy and large corporations. Tax cuts that will continue to ensure that we don’t spend enough on critical infrastructure. They are single-minded in their pursuit of starving the government of funds and, thereby, fundamentally changing the American way of life for the worse.
The American Nurses Association takes similar issue with this piece of legislation. First and foremost, the American Health Care Act would deny millions of Americans access to critical health care services. Although the Republicans in the House decided to blindly vote on this bill without knowing its financial or human impact, it is not substantially different from the previous version of the bill which would have resulted in a loss of health care coverage for 24 million Americans and an $880 billion reduction in Medicaid funding. This version, in fact, would also put at risk the ability of the roughly 15 million Americans with pre-existing conditions to purchase and access critical health care services. The process by which the legislation moved through the House was also striking for its lack of transparency and the absence of meaningful debate, stakeholder input, or bipartisan collaboration. The House, in short, was reckless in its determination to pass this flawed legislation.
Further, this legislation marginalizes vulnerable populations by eroding their ability to access health care services for the benefit of the wealthiest Americans, who would receive a large tax cut. Such a shift goes against ANA’s core principles of health care reform and, as Ms. Woodward pointed out, would fundamentally change the American way of life for the worse. The American Nurses Association stands in opposition to this bill and urges the Senate to take a far more judicious and bipartisan approach to health care reform which ensures that all Americans – rich and poor, young and old, sick and healthy alike – have access to comprehensive health care services.
A newly published Commonwealth Fund study sheds light on the health care experiences of Medicaid enrollees when compared with privately insured and uninsured individuals. Accessibility and quality outcomes for Medicaid enrollees have long been subjects of heated debate. Proponents of Medicaid expansion note that access to and use of health care services – particularly preventive care – through Medicaid reduces emergency department utilization and the cost to hospitals of uncompensated care. The Trump Administration recently reversed an Obama Administration policy of withholding federal funds to states to fill in financial holes for hospitals’ uncompensated care costs, which was meant to encourage states to expand Medicaid. This policy reversal comes in spite of evidence that Medicaid expansion has significantly reduced uncompensated care costs and improved hospitals’ financial stability. These arguments also ignore the fact that Medicaid provides access to comprehensive health care services for vulnerable populations including children, the elderly, and the disabled. Medicaid also provides critical services such as maternal care, mental health and substance use disorder services, and long-term services and supports like nursing home care.
The results of the Commonwealth study demonstrate the value of the Medicaid program from an access standpoint. This study surveyed adults with Medicaid for the full year, adults with private insurance for the full year, and adults with no coverage either at the time of the survey or at some point in the past year. The study found that Medicaid enrollees generally have access to care at rates comparable to those experienced by the privately insured population. Medicaid enrollees reported better care experiences than those without insurance and similar experiences to those with private insurance. Medicaid enrollees also received preventive care at a rate similar to that of individuals with private insurance and at a much higher rate than those without insurance. Medicaid enrollees also had fewer issues paying medical bills and had fewer instances of cost-related access issues than both the privately insured and uninsured populations.
The results of this study demonstrate that Medicaid provides access to crucial health care coverage for low-income and vulnerable populations. This is yet another piece of evidence that Medicaid expansion has moved the U.S. health care system toward achieving the American Nurses’ Association’s principles for health care reform: universal access to a standard package of essential health benefits for all citizens and residents; utilization of primary, community-based and preventative services while supporting the cost-effective use of innovative, technology-driven, acute, hospital-based services; the economical use of health care services with support for those who do not have the means to share in costs; and a sufficient supply of a skilled workforce dedicated to providing high quality health care services.