Senate ACA replacement bill would be a dangerous regression

July 13, 2017 Rod Hochman

This post originally appeared as a guest commentary in Modern Healthcare.

I always considered the Affordable Care Act more about health insurance reform than healthcare delivery reform. While far from perfect, it has expanded coverage to millions of Americans who were previously unable to afford health insurance. It also protects individuals with pre-existing conditions and ensures that every health plan offers consistent essential benefits.

Seven years later, I thought the national debate would finally shift from how we pay for healthcare to how we deliver it. By now, I thought the conversation would be about making Americans the healthiest people in the world and developing a healthcare system that’s affordable, high quality and convenient for everyone.

Instead, we’re back to square one. Rather than talking about how to advance the U.S. healthcare system, our nation’s leaders are talking about taking it backwards. The Senate Republicans’ Better Care and Reconciliation Act is essentially a tax plan, not a healthcare plan. It proposes cutting taxes for the wealthiest Americans by taking $772 billion out of Medicaid over 10 years. This means 22 million individuals would lose health coverage, according to an analysis by the Congressional Budget Office.

The proposal does not just roll back the ACA, it takes us all the way back to pre-1965 when Medicaid first began. In other words, the bill would eviscerate the Medicaid program.

As a nation, demographics indicate our population is getting older and poorer. We need to protect the health of these individuals, and Medicaid is a vital safety net that plays that role. Nearly all of us have loved ones or know someone who depends on Medicaid for their healthcare.

Medicaid supports 65% of all seniors in nursing homes. These are our parents and grandparents. The proposed “caps” don’t adjust for aging populations, which means the oldest, most-vulnerable members of society would be hardest hit.

In addition, 50% of all births are covered by Medicaid. Imagine if these newborns didn’t have access to care. That would have a profound effect on their long-term health. If children don’t have good care from the get-go, their cost of care becomes more expensive over time, and their ability to function fully in society could be compromised.

Medicaid is also a lifeline for other vulnerable populations, working including working people who don’t have the option of employer-sponsored health benefits and don’t make enough money to afford private insurance. Pulling the rug out from under millions of individuals–many who now have coverage and care for the first time–is not the answer.

Rolling back Medicaid also means a significant loss of coverage for mental health and substance abuse treatment. The opioid crisis alone is sweeping the nation, warranting a state of emergency. We are at a point where 23 veterans a day are committing suicide, and 39% of all disease burden is related to some form of mental illness. Medicaid is our nation’s largest payer of mental health services. It’s a travesty to consider cutting back coverage for mental health at a time when it is more urgent than ever.

Medicaid certainly has its flaws, and there is more that we can do on the provider side to improve the way we care for this population. For example, expanding access to primary care for Medicaid enrollees is one way we can identify health issues earlyand avoid more serious, costly care down the road.Likewise, offering better, more coordinated mental health resources is also critical to creating healthier communities while lowering overall costs in the long run.

I would much rather be talking about innovative solutions for improving Medicaid instead of dismantling it. If the leaders of our Congress would work together on a bill that aimed to make our health system better, I believe many Americans would welcome the collaboration and find it refreshing. It’s time to change the conversation and work toward real solutions, together.

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