The proposed Senate health care plan is coming under fire from some in Washington state who fear what the changes could bring to the thousands who were able to get health insurance under the Affordable Care Act, as well as facilities that treat them.
Washington Insurance Commissioner Mike Kreidler has been at the forefront of efforts to provide health insurance to those in Washington state who have gone without insurance for years, until the Affordable Care act was passed under the leadership of President Obama.
Kreidler worries the new plan calls the gradual reduction in the amount of money states receive from the federal government to pay for Medicaid. Kreidler says the plan calls for 90% funding until 2020, at which time it begins to be reduced until finally hitting just 50%.
He figures the result will be 600,000 low income, disabled people, and those in nursing homes in Washington will eventually lose their Medicaid coverage.
It’s unlikely the state could make up the difference.
“If you want to make up for it with state money as you take it down to essentially 50 cents on the dollar, it would be every year about $1.3 billion," Kreidler said. "Given all the challenges the legislature has right now in trying to fund education and meet the McCleary decision, you obviously have a problem in coming up with those kind of dollars.”
There are 1.9 million people on Medicaid in Washington, many of them who came on the rolls because the expansion under the Affordable Care Act.
Besides the Medicaid funding issue, Kreidler worries that the coverage of the new Senate plan might also ending up being woefully inadequate.
“If you end up dumbing down the insurance so it doesn’t cover much of anything and therefore it is cheap, because it doesn’t cover much, you still have insurance, but is it really insurance? Just because you can say I have insurance and it’s all the same, it’s not,” Kreidler said.
The community health centers across the state serve a number of lower income residents, most of whom receive their health care coverage through Medicaid. Leanne Berge, the CEO of Community Health Plan of Washington and the Community Health Network, says while Medicaid reimburses the clinics for care, it also pays for a number of services they provide, which would likely have to be cut ,as the funding dries up.
“In addition, the ability to have Medicaid coverage enables all types of innovative programming by the community health centers as well as by payers, which enable value –based contracting, and services that go beyond the traditional visits," Berge said. "It enables care coordination, care management, a team-based approach, programs for opioid addiction, programs that go way beyond just primary care services.”
Berge says the proposed cuts to Medicaid would affect everyone in the program, and not just those who came on board during the Medicaid expansion, under the ACA.
Also concerned with the changes are rural hospitals, who also relay on Medicaid funding.
Chris Bandoli of the Washington State Hospital Association says if the bill were to become law, he would not look forward to seeing the majority of the 600,000 people in Washington who were added to the Medicaid roll under the Affordable Care Act lose their coverage.
“So in absence of access to the expanded Medicaid program they are not likely to have insurance and will delay most likely some need health care services and when they show up it will be in our emergency department," Bandoli said. "So first it is not a good care path, and for the hospital itself, it’s uncompensated care that gets socialized through the rest of the healthcare system.”
Insurance Commissioner Mike Kreidler says the accomplishments of the Affordable Care Act in providing coverage to hundreds of thousands of Washingtonians who had no health insurance should not be taken lightly, and rather than overturn ACA, work should be done to improve it.
“We’ve done a great job here with what we’ve pushed, particularly if you consider what we had before the Affordable Care Act. It isn’t perfect, certain changes should be made, but destabilizing the market doesn’t serve the people of the state of Washington very well at all,” Kreidler said.
The fate of the Senate bill is not certain. Senate Majority Leader Mitch McConnell has now put off a vote until after the Fourth of July recess.