The Republican-backed healthcare overhaul that’s working its way through Congress this week would likely force huge spending cuts and leave thousands of people uninsured in Oregon if it’s approved – but many other changes being pushed in the legislation are unlikely to pass the Senate, panelists at the Oregon Health Forum told about 150 people who gathered Wednesday morning to learn about the law and its potential consequences.
But the details could still change, the panel’s two Washington, D.C.-based members noted.
“The committee is reviewing this bill and making changes as we speak,” said Ann Phelps, a principal in Deloitte Advisory’s Life Sciences and Health Care Practice committee, who noted that she and Julie Barnes, D.C.-based vice president of healthcare policy for Cambia Health Solutions, would probably check their phones throughout the hour-and-30-minute discussion to keep abreast of the evolving situation.
With Republicans hoping to pass a revised American Health Care Act before their scheduled upcoming April 7 recess, the bill is likely to go up for a House vote on Thursday, and if the Senate acts quickly President Donald Trump could sign the new law by April 8, Phelps said.
That raised numerous concerns with other panelists.
Patrick Allen, director of the Oregon Department of Consumer and Business Services, said Oregonians could lose coverage, rates for those remaining could rise, and insurance regulators might not have enough time or authority to adapt to changing federal rules.
Dr. Larry Mullins, president and CEO of Samaritan Health Services, noted that poor and at-risk patients stand to lose the most under the proposed law.
And Dr. Ralph Prows, chief medical officer for Adventist Health Medical Group, said he worries that the improvement in outcomes Oregon has seen following years of effort could be reversed.
“What’s really at stake here is losing all of the gains we’ve made, and all the investments we’ve made in Oregon to achieve those gains, from the last three to five years,” Prows said.
Efforts to control hypertension, manage diabetes, prevent cancer and boost access to care are just beginning to pay off, he said. “Everyone in this room who’s been a part of that feels a certain amount of pride in knowing how far we have come.”
AHCA would be limited to taxing, spending changes
But even though far-reaching policy changes have been proposed in the House version of the AHCA, much of that legislation will not be in the bill the Senate votes on, because of procedural rules that are limiting Republicans’ options, Barnes said.
For Senate Republicans to pass a policy bill, they would need to overcome a Democratic filibuster – and there’s no way they can muster 60 votes, she said. Only 52 Republicans are in the Senate.
“As a result, there’s just one mechanism that works – the budget process,” Barnes said. “If it’s not about taxing and spending, the Republicans have zero power to pass it” without Democratic support, she said. “Turns out, weirdly, Democrats are not interested in helping Republicans at this time.”
Even within those limits, the proposed changes have the potential to be far-reaching.
Philosophical Differences in Congress
The changes at the heart of the Republican push to repeal and replace the Affordable Care Act reveal a philosophical split in how the two parties are approaching this debate.
“The biggest issue, I believe, is the fundamental restructuring of Medicaid financing,” Phelps said, of the Republican approach. “What they are doing, bottom line, is taking an uncapped federal entitlement and capping it.”
“We’re trying to solve for a different problem than the Republicans in Congress are trying to solve for,” Allen said, speaking of Oregon’s healthcare reform efforts. “We’re trying to solve, how do you get everyone covered?”
“In Washington, the Republicans are trying to solve, how do you end the entitlement nature of Medicaid that was created in the 1960s?,” Allen continued. “How do you get the federal government out of something that many Republicans believe they should not be involved in at all, providing healthcare?”
That left Mullins worried.
“Most of us sitting in this room this morning have great people representing our interests,” he said, as he surveyed a crowd that included a number of healthcare industry leaders, in addition to policymakers and advocates. “For those populations that are most at risk, they’re more likely not to have the opportunity.”
Mullins said he wished he could get politicians to reexamine their priorities: “Keep the patient in mind, the impact of these decisions, put the politics aside, and try to make it work right.”
A Need for Reform
Yet even as officials in Oregon fret over the AHCA, Allen said the possibility that the bill might not pass keeps him up at night along with the possibilities if it’s enacted.
“Saying that this bill is terrible doesn’t mean that the existing Affordable Care Act is working,” he said.
Both the affordability of insurance purchased on the marketplace, and the financial stability of insurers, are at risk without some kind of action, he said. “I’m afraid that what will happen is that everyone will go to their respective corners and do nothing.”
In that case, some counties in eastern Oregon could find themselves with no private health insurance options at all.
With so much uncertainty, many healthcare organizations are bracing for cuts, Mullins said. “We’re all looking at cost-reduction efforts going forward. We’re all looking at potential layoffs. We’re looking at pharmaceutical pricing, how we deal with it and a potential redesign. More than anything else, we’re looking at how to continue this important work of redesigning the healthcare system in the best interest of our patients.”
What to Call the New Law
A humorous thread running through Wednesday’s often anxious conversation on federal health reform: What to call the American Health Care Act, following in the footsteps of the earlier Affordable Care Act’s “Obamacare” nickname.
Phelps pronounced AHCA’s abbreviation as “uh-CAW,” an avian, crowing sound.
Allen said the legislation reminded him of the old Bloom County comic character Bill the Cat, who frequently couched up hair balls while saying “ack,” and suggested calling ACHA “ack-cah.”
But Prows got the big laugh of the morning: “In all of the conversations right now, moving from ‘ah-ha’ (AHA) to “uh-CAW” (AHCA), we’re going to end up with ‘caca,’” he said, using a euphemism for excrement.
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Reach Courtney Sherwood at [email protected].
