All Americans, young, old or in between and poor, rich or middle income, deserve access to quality healthcare and to be protected from financial ruin when illness or injuries strike. Because the United States has the highest healthcare costs in the industrialized world ($9,400 per capita per year compared with the $3,800 per capita per year of other western countries), vast inequities in healthcare access have developed over time where only the wealthy can afford the quality care needed to prevent and manage disease and recover from injuries. In the last twenty years, fewer and fewer employers have been able to offer health insurance benefits. Skimpy “junk” policies which cover the fewest of basic services at the highest deductibles were the common individual plan from the insurance industry for the low and middle income consumer market.
The Affordable Care Act (ACA) was enacted to address these conditions and to bring quality healthcare to everyone. The proposed Senate bill (BCRA) does NOT achieve this goal. The BCRA not only eliminates the fair distribution of subsidies and the Medicaid expansion but also radically reduces the existing Medicaid program by placing caps on how much can be spent per enrollee for healthcare needs under a “Per Capita” system. Many Montana seniors are like my neighbor who only receives $500/month in Social Security and depends on Medicaid to meet her healthcare requirements. The hip replacement her doctor says she needs in the next year is exactly the type of costly expense which will probably be denied under the new “Per Capita” system.
The 77,000 Montanans in Medicaid expansion, 48 percent of them in rural areas, would lose their healthcare. Without assistance, there is no way a Montanan working full time, earning only minimum wage of $16,744/year, could afford the typical $4,000-$6,000 premium on the exchange and still pay for rent, food, electricity, heat in winter, and gas to travel to work.
I hear Senator Daines in his support of BCRA say that “healthy,” low income, single people don’t deserve the assistance provided under Medicaid expansion. So, how are my neighbor’s children who have asthma or diabetes supposed to continue disease management in their late twenties and thirties with inadequate income to meet those needs? And, such a statement assumes that single young people are not worthy of care when leukemia/Hodgkin’s lymphoma/ALS/schizophrenia strikes or injuries from vehicle accidents occur. Many rural hospitals, like Marcus Daly, would risk closure because Medicaid payments are critical financial lifelines. Prior to Medicaid expansion, Montana hospitals reported nearly $400 million in uncompensated care costs per year passed on to taxpayers and other insured patients.
This bill cuts the Medicaid program by $772 billion over a 10-year period. Over 240,000 Montanans (50% children) under the Medicaid program would see substantial reductions in services. Under Medicaid, 20,550 low income Montanans seniors in Medicare Savings Programs would lose assistance paying for Medicare coverage. The 65 percent of Montana nursing home residents with placement currently paid by Medicaid would be curtailed. Montana schools would lose payments for services to disabled children and mental health services for students. Existing programs and services of the Montana DPHHS are supported annually by 75 percent Federal funds. The Medicaid funds cut by BCRA represent a loss of $4.6 billion in Federal funding between 2020 and 2026 for Montana (over 1/3 reduction from current funds).
The BCRA disproportionately harms older Americans and people with pre-existing conditions. This bill would allow insurance companies to charge older Montanans five times more in premiums than younger people (ACA allows three times more). The tax credit structure under this bill would result in huge premiums that few seniors could pay. For example, the Bronze Plan premium for a Montanan 60 years old with an income of over $ 26,500 would jump from a subsidized level of $4,400/ year under the ACA to a premium of $16,000/year under BCRA (no tax credit available).
Under the BCRA, there are no annual limits on out-of-pocket expenses which help with the high costs of such things as cancer treatments, heart surgeries, and kidney dialysis for people with pre-existing conditions. Annual limits of $7,000 and $14,300 for families were established under the ACA and contributed to a 50 percent drop in personal bankruptcy rates since the ACA. Although the BCRA prohibits insurers from denying coverage to people with pre-existing conditions or charging them higher rates, it allows for excluding services from insurance policies by allowing states to waive Essential Benefits. This represents a de-facto barrier for pre-existing condition people to obtain plans that include the services they need at a cost that they can afford.
Politicians in their rush to scrap the Affordable Care Act are throwing out the baby with the bath water. The Medicaid assistance, increased Medicare benefits, fair distribution of subsidies, 3X premium limit for older Americans, annual limits to out-of-pocket expenses, and safeguards on insurance coverage to contain the most essential benefits needed are all important and worthwhile provisions to retain in any healthcare law drafted. The Senate needs to change directions and work towards improvement of the problems under the ACA: 1) more competitive plans in a few states, 2) instability of premiums, and 3) ever increasing deductibles and co-pays.
Please phone Senators Daines (202) 224-2651 and Tester (202) 224-2644 to urge them to vote NO on the BCRA. Ask them to support bipartisan efforts and hearings in the Senate to improve the ACA.