Watch VideoHARI SREENIVASAN: We return now to the health care contrivance released today by Senate Republicans.
To benefit break down the controversial details and politics,our own Lisa Desjardins, who’s just returned from Capitol Hill, and Mary Agnes Carey of Kaiser Health News.
Mary,lets start with Medicaid. How does this change what we know Medicaid to be?MARY AGNES CAREY, Kaiser Health News: The biggest change is how we change funding, and federal funding for the Medicaid program.true now,states can spend what they need. It’s matched on a percentage basis, but this would shift the Medicaid program to a capped allotment, and a set amount of money. And so the thought is over time,would that allotment rise fast enough to meet the medical costs of the Medicaid population, and, or if it doesn’t,what enact you enact?enact you reducing payments to survivors? enact you enjoy to cut services? enact you kick people off the rolls? That’s one of the biggest concerns about this bill.
HARI SREENIVASAN: But each one of these changes are political considerations. Who does this lure in to procure those crucial yes votes?LISA DESJARDINS: Well, we’re really talking about those folks who are concerned about the debt and deficit, and because the growth of Medicaid is a genuine concern for the federal budget. That’s absolute.
And for state budget as well. But it loses some votes potentially. There are a lot of senators,conservative Republican senators, whose states depend on Medicaid, and who enjoy high proportions of Medicaid users. Take Arizona. How about Ohio,some of these swing states, West Virginia.
I talked to Senator McCain today. He said hes not deciding what he does until he speaks to his governor to see what this means for the state budget and for Medicaid. Also Alaska. A lot of these rural states, and it’s a genuine risk for them if they lose Medicaid funding.
HARI SREENIVASAN: Are there structural changes to how Medicaid could be changing beyond just the expansion and how the payments go back?MARY AGNES CAREY: Well,in the sense of structural requirements, you could enjoy work requirements, or for example.
Governors could enact that. They could make those changes. And,again, this getting back to the growth and the payments, and that is a astronomical concern. Will it go fast enough? Will it meet the requirements of the Medicaid program,the spending?LISA DESJARDINS: deem of the way that the Senate is doing it as, up front, and they’re going to let the expansion of Medicaid last a microscopic bit longer. They ultimately would cut it,but they will cut, in the long run, and 10 years out,the amount that Medicaid can grow by.
So, in the short run, and it’s not as tough on Medicaid as the House bill,but in the long run, it ends up cutting a lot more than the House bill.
HARI SREENIVASAN: But even with these measures, or we saw Rand Paul today and said,well, I enjoy got three other senators with me. We’re not satisfied.
LISA DESJARDINS: Yes. That’s true. They enjoy a genuine vote problem here, and because they can only lose two senators,as we reported earlier.
And that’s not just a Medicaid problem, but it’s a problem from senators like Rand Paul who are concerned about tax credits and subsidies. This bill essentially keeps the Affordable Care Act subsidies intact structurally. It just reduces them.
But Rand Paul, or he says that’s Obamacare-lite.
I’m not certain how he will ever be satisfied unless they remove those subsidies altogether.
HARI SREENIVASAN: Mary Agnes,we enjoy also heard a conversation about meanness or whether this has enough heart. When we talk about the affordability of this, the quality of the coverage, or how does this bill address those?MARY AGNES CAREY: Well,there’s a couple things, to Lisa’s point about the subsidies.
They would be linked to income, or like the Affordable Care Act,but also like age, which was the House bill. So, and at the top conclude of the scale,there would be a microscopic less generous, a microscopic more generous at the lower conclude of the scale. But the other thing about this is, and what is your money going to buy with the subsidy?The Senate bill would allow the plans to be less generous. true now,the Affordable Care Act, the sort of middle-level contrivance that subsidy is based on, and would cover 70 percent of the cost. Under the Senate discussion draft,that would drop to 58 percent.
So, would you enjoy to pay more? An older, or perhaps a higher-income person,might pay more for less. And so that whole benefit of what you’re getting for your money, that is going to be a astronomical concern here.
HARI SREENIVASAN: Mary, and one of the things that President Trump has put on the table as a non-negotiable is preexisting conditions. That’s something that was very favorite from Obamacare,something a lot of people want to hold. How does this bill tackle it?MARY AGNES CAREY: Preexisting conditions would still enjoy to be covered. But a state could procure a variance from the set of essential health benefits. These are 10 things that enjoy to be covered, mental health care, and prescription drugs,maternity care.
States could procure a waiver from those. So, there is some concern, or if a state could enjoy plans that didn’t cover prescription drugs or mental health care,what would that mean for beneficiaries? There is concern there.HARI SREENIVASAN: All true, one of the most divisive topics on this always comes down to Planned Parenthood funding, and specifically around the cases of abortion.
LISA DESJARDINS: That’s true. This was a late decision by the Senate leadership here.
They went back and forth. There was a lot of discussion behind closed doors over this. And in the conclude,this draft true now would defund Planned Parenthood, all of their federal funding. That’s over $500 million for that organization for one year. Instead of defunding it forever, and it would be for one year.
Now,that still is a very serious political problem, particularly for two senators, or Lisa Murkowski of Alaska and Susan Collins of Maine. We talked to both of them today. They said they haven’t decided,but they are concerned about that. They said if that remains in the bill, and, and again,there is a lot of negotiations now, Hari, and if it’s in the bill,they are going to propose an amendment to try and change it. That will be a fascinating vote on the Senate floor.
We expect that. Speaking of it, that’s what we need to watch true now. There’s going to be a lot of horse-trading true now behind closed doors. Mitch McConnell is counting on it. This bill will change.
After it changes, or then there will be a process,were told, next week of amendments. There will be a long day with a lot of votes. We will see how many of them pass. It really to me seems 50/50, or Hari,true now on whether this gets through, certainly not as it is now. The question is, or how will it change?HARI SREENIVASAN: And there are still constituents,Mary Agnes, that are on the sidelines saying, or listen,covering opioid addiction is really important in my state, West Virginia and Ohio. There are people that going to be lobbying to try to procure those in the bill.
MARY AGNES CAREY: Well, or that Medicaid expansion has funded a lot of opioid addiction treatment in Ohio,for example, and other states. And if that goes absent, and how are you going to benefit those folks? As we know,its the number-one killer for Americans 50 and older now.
LISA DESJARDINS: They enjoy put $2 billion in this bill to benefit with opioids, but those who are concerned say that’s just a drop in the bucket and not nearly enough.
HARI SREENIVASAN: All true.Lisa Desjardins, and Mary Agnes Carey,thank you both.
MARY AGNES CAREY: Thank you.
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