After weeks of closed-door meetings, 13 Republican senators have come up with a draft health care bill as mean-spirited and destructive as the proposed House legislation to repeal and replace the Affordable Care Act (ACA) of 2010, aka Obamacare, passed on May 4.
Senate Committee on Indian Affairs (SCIA) member Jon Tester, D-MT, emailed ICMN this comment, “This bill was written in secret without any input from folks in Indian country. It will rip away Medicaid for thousands of Native Americans, make it harder to get coverage if you have a pre-existing condition like high-blood pressure or diabetes, and further strain local IHS and tribal health facilities.”
Sen. Tom Udall, D-NM, said in a statement: “Native Americans would be among those hardest hit by this disastrous Senate TrumpCare bill. As vice chair of the Senate Indian Affairs Committee, I’ve heard from many tribes who are deeply concerned about the lack of tribal consultation in TrumpCare – and about how devastating this bill would be for access to life-saving health care services in Indian country.”
The Senate released its draft health care bill on June 22. The legislation would continue to fund Medicaid expansion for three years and then initiate federal funding cuts beginning in 2021. In some states – Arkansas, Illinois, Indiana, Michigan, Montana, New Hampshire, New Mexico, and Washington – Medicaid expansion could end immediately if federal matching rates go below the rates promised in the ACA.
"The overall goal of health care reform legislation should be to provide all Americans with access to patient-centered health care and health insurance at an affordable rate. We are reviewing this legislation to determine whether it meets this standard and we also want to see a CBO score on the bill,” said Sen. John Hoeven, R-ND, who is chairman of the Senate Committee on Indian Affairs, in an e-mail to ICMN. “We need to stabilize the health insurance market to make it more competitive so consumers have access to better and more affordable health care policies. At the same time, we need to ensure that low-income individuals, have access to health insurance either through Medicaid or through tax credits based on age and income. We're reviewing the policies in the bill to ensure that Medicaid is sustainable in the future and can work for those who rely on the program."
States would receive Medicaid funding in the form of a block grant with a set amount of money allowed for each person enrolled in the program. Increases would be indexed to inflation, not to the cost of medical services as they are in the ACA, beginning in 2025. Even though these cuts are more gradual than those proposed in the House bill, they end up being more drastic.
Sen. Al Franken, D-MN., a member of the SCIA, wrote in an email to ICMN, “Just like the health care bill in the House of Representatives, the Senate Republican’s plan would still destroy Medicaid as we know it. In Minnesota, we’ve seen expansion of the program make it possible for Indian Health Services (IHS) to provide more local and comprehensive treatment for members of our tribal communities. IHS funding is still not where it needs to be, and I find it alarming that the Republican health care bill would actually make deeper cuts to Medicaid over a longer period of time to give billions of dollars in tax breaks to the very few richest Americans. This is unacceptable.”
In an email, a spokesman for Sen. Steve Daines, R-MT, a member of the SCIA, has a more positive view, “The discussion draft leaves the Indian Health Care Improvement Act (IHCIA) intact. It fully funds the Montana Medicaid Expansion, which is scheduled to end in June 2019. It would provide financial support for low-income tribal and non-tribal members for the purpose of purchasing insurance, if they are not eligible for Medicaid.” Daines said, “I’m glad to see the draft text of the bill made public for everyone to see. I look forward to hearing directly from Montanans on this legislation, including on the 17th teletownhall I’ll be hosting next Wednesday (June 28).”
The ACA’s federal subsidies to help people who don’t qualify for Medicaid to pay for health insurance would be greatly reduced under both the Senate and House bills. In the Senate version, subsidies would not be available for people earning more than 350 percent of the poverty level. Under the House version, tax credits to help pay insurance premiums would be based on age, not income, and would top out at $4,000.
Under the ACA, all insurance plans are required to pay for essential health services, such as hospital stays, maternity coverage and mental health treatment. Both the Senate and House bills allow states to define what essential services insurance companies must cover.
Sen. Martin Heinrich, D-NM, said in an email to ICMN, “The health care bill that Senate Republicans released would be devastating to tribal communities who have long faced challenges with access to affordable health care, insurance, and services. It would strip billions from Medicaid and effectively end Medicaid Expansion, which has been the primary driver for increasing health coverage for Indian country over the last few years. Americans living in rural and tribal communities would lose access to health coverage that has helped their families—and in some cases even saved their lives.”
The Congressional Budget Office is expected to review and score the Senate bill this weekend and a vote could come as early as next week, before Congress adjourns for its July 4 recess.
Tester said in his email to ICMN, “Politicians in Washington must understand that providing access to quality health care in Indian country is more than a talking point, it is a trust and treaty responsibility to Native American families.”
You may phone or e-mail your senators to let them know what you think about the proposed legislation. Go here. In the upper left hand corner is a link to “Find Your Senators.” Select your state from the drop down menu and the next screen will show your two senators’ names along with their phone numbers and links to their emails.