The latest attempt by the U.S. Senate to repeal and replace the Affordable Care Act has failed to garner support from Maine’s senators. Though the bill does eliminate some unpopular provisions from earlier versions, the changes aren’t enough to gain traction with Sens. Collins and King, and Maine health providers.
Previous proposals to repeal and replace the Affordable Care Act have included tax breaks for high income earners. Those tax breaks have been scaled back in the latest version of the Senate bill, called the Better Care Reconciliation Act. There’s also more funding included to fight the opioid epidemic: $45 billion over the next decade. But one big problem remains: cuts to Medicaid.
Sen. Susan Collins tweeted that’s the reason she can’t support this latest proposal. Neither can Vanessa Santarelli, CEO of the Maine Primary Care Association.
"The deep cuts to the Medicaid program could be really damaging, particularly to a state like Maine and to our community health centers,” Santarelli says.
About one-quarter of patients at Maine’s community health centers are covered by Medicaid, says Santarelli. Medicaid also covers more than 60 percent of the cost in Maine for long-term care for seniors and people with disabilities.
As in previous versions, this latest Senate bill would end the federal government’s commitment to fund the program as spending fluctuates and instead institute a cap. Santarelli says that would shift costs to states — and that means the cuts would affect more than just those who rely on Medicaid for health care.
"Any program funded through the general fund, or state agency, should be concerned because as downward pressure is put on the state budget, it will result in legislators having to look to other programs and services to make cuts,” she says.
The Medicaid cuts, she says, are also why the extra $45 billion in spending on the opioid epidemic isn’t enticing.
“While providing additional money to fund substance use disorder treatment services is good, it should be done in conjunction with securing high quality health insurance plans for all Americans,” says Santarelli.
The Maine Hospital Association also opposes cuts to the Medicaid program. Spokesman Jeff Austin says it’s a lopsided approach that traps hospitals when they face higher costs.
“Unless they want to cap input costs, like pharmaceutical costs, then capping our revenue, it just sets us up for failure," Austin says.
Another major problem in the Senate bill, says Austin, is that it would allow insurance companies in the online marketplace to offer catastrophic plans so long as they offer at least one plan with comprehensive coverage. Those catastrophic plans would cover less and therefore be cheaper, likely attracting younger, healthy people. But Austin says that would drive up premiums for older, sicker consumers who need robust health coverage.
“You need younger, healthy to pay premiums to help support older, sicker people,” says Austin. “And if they jump out of the pool they’re in, and into the catastrophic plan pool, you destabilize that first pool that the older, sick ones are in. That’s the big concern.”
Overall, says Lori Parham of the Maine AARP, the bill accomplishes what previous proposals did: higher costs and less coverage.
“The bill may have changed, but the results are the same,” Parham says.
That’s Sen. Angus King’s conclusion as well. He called the plan “terrible” and says a bipartisan approach is needed to improve health care. Sen. Susan Collins also tweeted that she’s ready to work with her Republican and Democratic colleagues to fix flaws in the Affordable Care Act.
A vote on this latest Senate bill is expected next week.
