Though the four conservatives who have voiced opposition to the bill might be pushed hard - Sens. Pressure is coming from outside groups on the right. The Senate bill would extend "quite robust" tax credits to many people, he said, even to those living in poverty who were not eligible for Medicaid: "Republicans have a different view of what a safety net should look like." People too often equate federal spending with establishing a safety net, when greater competition and a free market could produce better results at a lower cost, in Roy's view. "I think that it's absolutely essential to putting (Medicaid) on a sustainable path so that it will be there for future generations."Īvik Roy, a conservative health expert who serves as president of the Foundation for Research on Equal Opportunity, said the legislation's proponents need to show "that competitive insurance markets can work for the poor and the vulnerable and the sick." "The idea that there's a sector of our economy that has to permanently have a higher inflation rate than the rest of our economy is ridiculous," Toomey said Thursday. Beyond Medicaid, it would permit private health plans to cover fewer services and would allow individuals and employers to eschew coverage without penalty - elements that its authors say could lower how much consumers pay for their insurance. Patrick Toomey, R-Pa., one of the bill's champions, said it would establish "a very, very gradual and gentle transition to a normal inflation rate" for a program in which he said costs were spiraling out of control. But the analysis showed that the greatest damage would come in McConnell's own state: Kentucky, which has had the nation's largest Medicaid expansion under the ACA, would see a 165 percent jump in unpaid hospital bills. Hospitals in West Virginia would suffer an even greater spike in uncompensated care, about 122 percent during the decade. It examined the House legislation but noted that the Senate bill would doubtless hit harder because of its deeper reductions in federal Medicaid payments. Some of the most reticent senators come from states where health-care systems stand to lose the most financially if the bill passed.Īccording to an analysis by the Commonwealth Fund, hospitals in Nevada would be saddled over the next decade with at least double the costs in "uncompensated care" - bills for which neither an insurer nor a patient paid. To some extent, the division within the GOP's ranks reflects geography. It will lead to disabled children not getting services. It will hammer rural hospitals, it will close nursing homes. history," said Bruce Siegel, president of America's Essential Hospitals, a coalition of about 300 hospitals that treat a large share of low-income patients. "There has never been a rollback of basic services to Americans like this ever in U.S. Then, four years later, the federal government would apply an inflation factor to spending increases that would be equal to the urban consumer price index rather than the higher medical inflation rate used in the House bill. What is now an open-ended entitlement, with federal funding available for a specific share of whatever each state spends, would be converted to per capita payments or block grants. The expansion, which has provided coverage to roughly 11 million people, would be phased out. Under the Senate GOP version, 2021 is when Medicaid's transformation would begin.
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