Welcome to Practice Rounds, our weekly column exploring what's being covered in the larger world of healthcare.
The Republican Senate's draft of the American Health Care Act (AHCA), the effort to repeal and replace the Affordable Care Act (ACA), was revealed to the public this week after it was negotiated in secret. There are a number of provisions very similar to the AHCA bill that passed the House by a vote of 217 to 213, with some alterations included.
Like the House bill, the bill eliminates the ACA's individual mandate to purchase healthcare insurance and the employer mandate that requires large employers to offer insurance. Both bills remove cost-sharing subsidies that help insurers pay for low-income customers and enact a one-year funding freeze of Planned Parenthood. They also both end the Medicaid expansion and cut funding to the program.
Unlike the House bill, the Senate bill doesn't incentivize healthy people to stay insured. The House did this by proposing a 30-percent surcharge on consumers who buy a new health plan after letting the previous one lapse. Another change from the House to Senate is that the latter keeps the ACA's requirement of insurers not being able to increase someone's premiums or deny coverage based on a pre-existing condition. The House bill gave states the right to allow insurers to do that, as long as they set up high-risk pools to cover the sickest residents. According to Politico, the Senate bill does allow states to waive insurance rules and weaken protections for certain medical conditions.
In terms of ending the Medicaid expansion, the House bill would start a rollback in 2020 and the Senate is over a three-year process, starting in 2021. Politico reports the Senate bill also cuts Medicaid funding more significantly than the House bill. Overall though, politicians from both parties agree that there isn't a huge difference in the two bills.
The Senate bill needs 51 votes to pass through a reconciliation process. If it gets 50 votes, Vice President Mike Pence would provide a tie-breaking vote. If it passes, it moves back to the House, where it can either be voted on as is, or a conference committee would be used to resolve differences. Once it passes the House again, it moves to the White House, where it can be signed into law or vetoed. According to Politico, Senate Majority Leader Mitch McConnell is aiming to have a vote on the AHCA by late next week.
The White House has yet to speak out against or in favor of the Senate AHCA bill. Media reports indicate that President Trump called the House version of the bill, "mean" and he asked the Senate to draft a nicer version.
Medical Groups: Thumbs Down to AHCA
Similar to the House version of the AHCA, medical groups came out against the Senate's bill not long after it was released to the public. The American Hospital Association released a statement saying it urges the Senate to go back to the drawing board and develop legislation that continues to provide coverage to all Americans who currently have it.
In a statement, the American Academy of Pediatrics said, "The bill fails children by dismantling the Medicaid program, capping its funding, ending its expansion and allowing its benefits to be scaled back. The bill fails all children by leaving more families uninsured, or without insurance they can afford or that meets their basic needs." The American Psychiatrists Association, American Lung Association, National Association of County and City Health Officials, and March of Dimes were among the other groups to make statements denouncing the bill.
Quote of the Week
"I am not a reporter, and I am not a lobbyist, so I’ve seen nothing."
Sen. Lisa Murkowski (R-Ala.) before the text of the Senate version of the AHCA was released to the public.