STATE HOUSE, BOSTON, MARCH 8, 2017....As a Congressional committee on Wednesday prepared to take up health care legislation offered as a replacement for the Affordable Care Act, U.S. Rep. Richard Neal knocked the plan as a one that would force "millions to pay more to get less health care."
"This bill suffers from an identity crisis," said Neal, dean of the Massachusetts delegation and ranking minority member of the House Ways and Means Committee. "Is this health care or is this a tax cut bill? Is it lower cost? No. Does it bend the cost curve? No. Does it cover more Americans? No. Does it cut the deficit? No."
The Ways and Means Committee Wednesday began working on a markup of the American Health Care Act, a plan put forward Monday night by Congressional Republicans. Democrats asked often pointed questions and received evasive and incomplete answers. On the House floor, Rep. James McGovern of Worcester said the bill was being marked up without public hearings, a Congressional Budget Office score, or the benefits of "expert testimony."
The draft bill has quickly generated criticism in Massachusetts, the state whose 2006 universal health care is considered the model for the federal health care access law known as the Affordable Care Act or Obamacare.
The bill would eliminate individual and employer coverage mandate penalties and transition Medicaid payments to states into a per-capita allotment. It would retain some features of Obamacare, including a prohibition on denying coverage based on pre-existing conditions and a provision that allows young adults to remain on a parent's plan until age 26.
U.S. House Ways and Means Committee Chairman Kevin Brady, a Texas Republican, said the bill "aligns with the president's goal of rescuing Americans from the failures of the Affordable Care Act."
He said the legislation expands health savings accounts so they can be used to cover more expenses and creates a monthly tax credit, based on age and family size, that low-income and middle-income Americans can use to purchase health coverage.
House Speaker Paul Ryan, a Wisconsin Republican, called Obamacare a "disastrous law" that is "rapidly collapsing."
"The American Health Care Act is a plan to drive down costs, encourage competition, and give every American access to quality, affordable health insurance," he said in a statement. "It protects young adults, patients with pre-existing conditions, and provides a stable transition so that no one has the rug pulled out from under them."
Massachusetts health care advocates voiced concerns that the proposal -- particularly its rollback of expanded Medicaid eligibility -- could put residents at risk of losing coverage.
"This draft bill would break the fundamental contract we've had in Massachusetts for over 10 years - that everyone has the right to affordable health insurance," Health Care for All spokeswoman Maria Gonzalez Albuixech said in a statement.
The legislation would end Medicaid expansion in 2020, a move Gonzalez Albuixech said would "leave hundreds of thousands of Bay Staters with no source of coverage at all." She said a proposal to change health plan subsidies from an equity-based, sliding scale system to one based solely on age "would hurt the people who need help the most."
Vic DiGravio, president and CEO of the Association for Behavioral Health Care, said Medicaid is the largest payer of behavioral health treatment in Massachusetts and nationally and that his group is concerned the GOP plan will ultimately result in fewer people having access to treatment.
"Our members have wait lists across the board for outpatient services, for residential services," DiGravio told the News Service. "Repealing the ACA and repealing the expansion is going to make it harder for people to get access to treatment. We're going to see more people in jails, more people in emergency rooms, more people in homeless shelters."
The Medicaid reform proposal would "significantly cut federal funding just as our state's elderly population is expected to increase significantly," Mass. Senior Care Association President Tara Gregorio said in a statement, noting two-thirds of the Massachusetts nursing home population rely on MassHealth, the state's Medicaid program, to pay for care.
An Associated Industries of Massachusetts summary of the proposal said the change in how Medicaid is funded -- moving from claims-based to per capita allocations by 2020 -- could potentially reduce funding to eligible recipients in the state.
The bill also establishes a "Patient and State Stability Fund" that would provide states with $100 billion over nine years to design programs promoting participation and stabilizing risks in the individual health insurance market, according to AIM.
"That provision has a down side for Massachusetts," AIM's Russ Sullivan wrote in a blog post. He said 15 percent of the fund's money is available only to states that either experienced an increase in the uninsured population below the poverty level from 2013 to 2015 or that have fewer than three health insurance plans available on their state exchange in 2017.
House Republicans say they are "still discussing details" of how their plan will be paid for and what it will cost. Neal said considering the legislation before it was fully evaluated and scored by the Congressional Budget Office "is not only puzzling and concerning, it is also irresponsible."
Attorney General Maura Healey urged Congress to reject the bill.
"The House Republican bill would jeopardize health care coverage for millions of Massachusetts residents," she said in a statement. "Without any estimate of the bill's costs or impacts, it proposes to raise premiums on the elderly, dismantle assistance for the vulnerable, defund Planned Parenthood, and cut funding for Massachusetts health care programs by hundreds of millions of dollars."
The originally appeared in the State House News Service on March 8, 2017.
