WASHINGTON — A challenging and unresolved issue hindering the advancement of President Donald Trump’s significant legislative proposal in Congress is how to slash billions from healthcare funding without detrimentally impacting Americans or the institutions that provide medical services.
Republicans are in a quandary trying to devise strategies to address the healthcare issues their legislation has conjured. Current projections indicate that under the House-approved version, an additional 10.9 million individuals would lose their health insurance. GOP senators have suggested even steeper reductions, which, according to some, may be too extreme.
“The Senate’s Medicaid cuts are considerably deeper than those from the House, which I find problematic,” commented GOP Sen. Susan Collins of Maine.
Behind closed doors, senators have been holding discussions with Trump administration officials as they race against time to finalize the substantial bill before President Trump’s deadline of the Fourth of July. Much of the proposed legislation, which includes tax reliefs and enhanced border security funding, is essentially prepared. However, determining the extent and reach of healthcare cuts remains one of the most challenging issues.
This situation echoes the summer of 2017, during Trump’s initial term, when Republicans wrestled to honor their campaign vow to “repeal and replace” the Affordable Care Act, also known as Obamacare, only to witness the GOP split over the prospect of Americans losing their health insurance. That legislation ultimately failed when then-Senator John McCain famously cast a decisive “no” vote.
Senate Majority Leader John Thune is fervently working to prevent a repeat of that scenario, adhering to the timetable and pushing forward with a vote anticipated by week’s end.
“This is a solid bill, and it holds great promise for our nation’s future,” Thune proclaimed Wednesday, extolling its potential for igniting economic growth and increasing disposable income for citizens.
The revisions to federal healthcare programs, largely Medicaid, were expected to be pivotal elements of the GOP proposal, serving as a mechanism to balance the costs associated with offering tax breaks to millions of Americans. Should Congress opt for inaction, taxpayers would face increased levies next year as existing tax laws are set to expire.
The bill previously passed by the House accomplished approximately $1.5 trillion in total savings, a significant portion resulting from healthcare modifications. Over the past 15 years since Obamacare’s inception, Medicaid has seen substantial growth and now benefits nearly 80 million Americans. Republicans argue this figure is excessively large and advocate for downsizing the program to primarily support poorer women and children.
House Democratic Leader Hakeem Jeffries has accused Republicans of attempting to deny healthcare access to tens of millions of Americans, with Democrats staunchly opposing what they term a “big, ugly bill.”
A substantial amount of the projected healthcare savings comes from new requirements mandating 80 hours of work per month for Medicaid beneficiaries, despite most already being employed.
However, another contentious component is the so-called provider tax, imposed to varying degrees by states on hospitals and other Medicaid service providers, a move that poses significant risks for rural hospitals.
Senator Josh Hawley, R-Mo., noted that several senators expressed hesitancy about proceeding to a vote during a private meeting on Wednesday, citing concerns about rural hospitals as a crucial factor.
States levy these taxes primarily to secure increased Medicaid reimbursements from the federal government. Critics label the practice as a form of “laundering,” but with the exception of Alaska, nearly every state employs it to help facilitate healthcare coverage.
The House-passed bill aims to freeze provider taxes at existing levels, while the Senate’s plan seeks further reductions in the taxes some states are authorized to levy.
“I recognize that states have grown reliant on this tax,” commented Sen. Roger Marshall, R-Kan. However, he continued, “It’s clear the provider tax needs to be eliminated.”
Nonetheless, numerous GOP senators, alongside hospitals and other medical entities within their jurisdictions, are voicing strong objections due to concerns that the changes could devastate rural hospitals.
The American Hospital Association has made an appeal to legislators, highlighting that the cuts would not only affect Medicaid individuals but also burden emergency rooms as they transform into primary healthcare providers for millions suddenly without insurance.
“Even worse, some hospitals, particularly those in rural areas, may be compelled to shut down completely,” warned Rick Pollack, the hospital group’s president and CEO.
The Catholic Health Association of the United States has emphasized that Medicaid is responsible for insuring one in every five people and nearly half of all children.
“The envisaged Medicaid changes would unleash devastating impacts, notably within small towns and rural locales, where Medicaid is frequently the dominant healthcare resource,” stated Sister Mary Haddad, the president and CEO of the organization.
In an effort to address the healthcare dilemma, senators are considering establishing a rural hospital fund to offset Medicaid funding deficits.
Republican senators circulated a proposition to allocate $15 billion towards founding a new rural hospital fund. Opinions are split, with some claiming this allocation is too generous, while others argue it falls short. Collins has proposed the fund amounting to $100 billion.
“It won’t reach that magnitude,” said Thune, “but there will be a fund.”
Hawley, a prominent critic of the healthcare cuts, expressed interest in the rural hospital fund but remains eager to understand its functionality.
Concerns have also been raised about a new $35 per service co-pay that Medicaid recipients might face, included in both the House and Senate versions of the bill.
“Securing the fund is a positive step. It’s vital, a move in the right path,” stated Hawley, yet he questioned, “How will the fund disburse the money? Who is responsible for allocating it to the hospitals? … Or will this merely be a concept on paper?”
In a newly released analysis, the White House Council of Economic Advisers estimates that the legislative package could mean up to $2.3 trillion in deficit reduction over a decade, a significantly different forecast than other evaluations provide. Conversely, the nonpartisan Congressional Budget Office’s dynamic scrutiny of the House-approved measure anticipates an increase in deficits by $2.8 trillion over the next ten years.