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GOP Senate Bill Would Cut Health Care Coverage By 22 Million

Doctors, nurses, patients and activists listen to Senate Minority Leader Chuck Schumer, D-N.Y., speak about Senate Republicans' health care bill on Friday at Bellevue Hospital in New York City. Schumer has vowed to help defeat the legislation, which the Congressional Budget Office scored on Monday.
Spencer Platt Getty Images
Doctors, nurses, patients and activists listen to Senate Minority Leader Chuck Schumer, D-N.Y., speak about Senate Republicans' health care bill on Friday at Bellevue Hospital in New York City. Schumer has vowed to help defeat the legislation, which the Congressional Budget Office scored on Monday.

GOP Senate Bill Would Cut Health Care Coverage By 22 Million
GOP Senate Bill Would Cut Health Care Coverage By 22 Million GUEST: Vernita Todd, senior vice president for external affairs, Health Center Partners of Southern California

. This is KPBS Midday Edition. I am Maureen Cavanaugh it is Tuesday, June 27 . It is not clear if yesterday's numbers from the Congressional Budget Office were the reason that the Senate is delaying a vote on its healthcare bill but the numbers could not have helped. The Congressional Budget Office found that the Senate proposal would cause the number of Americans without health care coverage to rise by 22 million people in the next 10 years. Governor Jerry Brown railed against the bill and its CBO score on a conference call this morning. This is bad for people. Millions and millions of people are going to suffer. That is a crazy thing for elected representatives to inflict on people. Meanwhile San Diego health administrators are scrambling to figure out how the proposed changes would affect healthcare here. Joining the is for Nita Todd senior vice president for healthcare California. She is in Washington DC. Thank you for joining us. It is my pleasure. You are in Washington. How big of a surprise is this delay until after the recess? It is not a surprise after the CBO report yesterday and so many lawmakers had come out in opposition on both sides of the issue. Had become pretty clear that the Senate leader was going to have trouble getting to 50 votes this quickly. Any help us understand this report? For instance, when that estimate is that 22 million more people would be left uninsured what are they basing that on? What are the key factors in the Senate Bill that would raise the number of uninsured. There are three basic things one is the decrease of the number of people on Medicaid or Medi-Cal in California because of the elimination of the expansion we would see many people losing their character the Medi-Cal program. That is going to represent a significant number. California for example 3.7 million Californians enrolled in Medi-Cal after the expansion. Many of those families will have to make choices. Secondly folks are removed from the individual mandate. When I say folks will be uninsured a portion of those folks will be uninsured because they choose to be. That is the point that we have to make and be clear so we are sure we are sharing the fact. Without the individual mandate some folks will be uninsured because they do not desire to have coverage. I believe the largest share of folks other than the Medi-Cal population he will do without are people who just cannot afford to purchase coverage. The help been given is less the coverage is less and the premiums are suggested to be higher. We believe that those families, many of them who are low income or just be a -- above low income will not have access to affordable quality healthcare. The CBO also said the bill will decrease average premiums by about 20% quick that -- will that still be too high for the people you are talking about? It will decrease premiums but it will also decrease benefits. There will be a higher deductible in order to do that. People are looking at Doctor bulls that are still pretty expensive to them. With these lower-cost premiums meaning $10,000 of out-of-pocket cost for you prior to your insurance kicking and. We have families that may be able to buy catastrophic plans but if that young lady by the plan and has a baby or gets pregnant the maternity care is not covered in that. She cannot be expected to pay another $17,000. What did the CBO say about people who get healthcare through their employers? Scarily enough the changes that they make in the better care reconciliation act people with employer-based insurance are not immune from the changes in the slot. -- In this law. One thing about that protections go away and limits and out-of-pocket cost and free preventive services. There is also a concern that employers are no longer mandated to provide you insurance that they could go back to offering catastrophic plans that do not cover the needs and services that your family needs and so your insurance if you have it through your employer is at play now as well. It is not only Medicaid. Vernita, you spoke earlier about the idea that some people may be able to afford insurance plans that have extremely high deductibles and do not really provide that much coverage. The Senate bill let's states take waivers so insurance companies can provide those kinds of policies. They would not have to offer coverage for certain conditions like mental health or like you were saying maternity care. In a news conference today Governor Jerry Brown would not definitively say the California could get a waiter so insurance companies could offer catastrophic plans without mental health or maternity care. California has really led the nation in the implementation and adoption of the affordable care act. It is something that our state legislatures believing that the residence in California believe in. However down the line as those but -- Medicaid start to become more real. What you find as you begin to pit populations against each other. What the 40% cost covers beneficiary -- Medicare beneficiaries. 11 elderly population and a disabled children against a poor groups and -- prison population against children against working adults. At some point you will have to cut benefits or talk about eligibility or you will have to find ways to make this stretch. Breast California is a beacon of light in this fight when it comes down to a $20 billion loss that the GDP of California could face over the years I can imagine that tough decisions will have to be made by legislators. I cannot imagine that they would want to offer those waivers but there will come a point when 14 million people on the Medicaid program in California with limited dollars you have to make as good a decision as he can to keep what you do have go in. It is unlikely but it is not out of the realm of possibility. I have been speaking with Vernita Todd senior vice president for the Health Center partners of Southern California. She is in Washington DC thank you very much. Hope you have a great day.

Updated at 8:10 pm ET

Congressional forecasters say a Senate bill that aims to repeal and replace the Affordable Care Act would leave 22 million more people uninsured by 2026.

That's only slightly fewer uninsured than a version passed by the House in May.

Monday's report from the nonpartisan Congressional Budget Office could give moderate senators concerned about health care coverage pause. Sen. Susan Collins, R-Maine, was quick to register her opposition to the bill.

Senate Republican Leader Mitch McConnell wants a vote on the bill this week, before senators head home for the July Fourth recess. With Senate Democrats united in opposition, Republicans can afford to lose only two votes on their side and still pass the bill.

Sen. Dean Heller, R-Nev., who is up for re-election next year, had already expressed reservations about the number of people who could lose coverage under the GOP bill. Four other Republican senators have complained that the bill doesn't go far enough in rolling back the Affordable Care Act, also known as Obamacare.

According to the CBO, the Senate bill does reduce the deficit by $321 billion over the next 10 years, which $202 billion more than the House version that passed last month.

The Senate bill would cut hundreds of billions of dollars in taxes over the coming decade, with most of the savings going to those at the top of the income ladder. At the same time, it would phase out the Affordable Care Act's Medicaid expansion, while offering less generous subsidies to those who purchase health insurance on the individual market. That combination is expected to reduce the number of people with insurance coverage by 15 million in 2018 and 22 million by 2026.

The CBO says low-income Americans in their 50s and early 60s would be disproportionately likely to lose their health care coverage under the Senate bill.

Although people buying insurance in the individual market would see lower premiums in many cases, the policies would cover less, and out-of-pocket costs would be higher.

"Despite being eligible for premium tax credits, few low-income people would purchase any plan," the CBO said.

The Trump administration challenged the findings.

"The CBO has consistently proven it cannot accurately predict how healthcare legislation will impact insurance coverage," said an unsigned statement from the White House. "President Trump is committed to repealing and replacing Obamacare, which has failed the American people for far too long."

For months, the administration has pointed to rising insurance premiums and reduced competition among insurers to argue that a replacement for the ACA is urgently needed.

However, CBO forecasters predict the insurance market will remain stable for most of the country, with or without the Senate bill. The report notes that government subsidies under Obamacare help to insulate most purchasers from rising costs.

Moreover, the report blames actions of the Trump administration for driving some insurance companies out of the market, with "substantial uncertainty" over its enforcement of the requirement that individuals carry health insurance and its threats to withhold payment of cost-sharing subsidies.

Eventually, the Senate bill could have even more far-reaching effects than the CBO forecast shows.

For the first time, the Senate bill would cap federal spending on Medicaid in 2020, forcing state governments to either scale back the safety-net program for the poor and disabled, or make up the difference out of their own budgets. The Senate bill also assumes that after 2025, Medicaid bills will grow more slowly than they have historically. If that assumption is wrong, states would face an even bigger budget gap that would grow with each passing year.

Sen. Ron Wyden, D-Ore., said he worries the CBO report doesn't fully reflect those long-term effects, since the forecast is focused on a 10-year budget window. Wyden, the ranking Democrat on the Senate Finance Committee, wrote a letter to CBO Director Keith Hall, asking him to assess how the Senate bill would affect Medicaid coverage 20 or 30 years into the future.

"It is critical that Senators completely understand legislation and its impact prior to casting a vote," Wyden wrote.

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