KXLH – June 9, 2017
U.S. Sen. Steve Daines says his fellow Senate Republicans will produce their version of a bill rewriting the Affordable Care Act “soon” – and that he expects it to stabilize health-insurance markets and lead to more affordable coverage.
Daines also told MTN News in an interview this week the GOP bill likely will preserve federal Medicaid-expansion funding through 2020, to cover low-income citizens – but start scaling it down in the following years.
“The expansion right now is adding a trillion dollars of cost in the next 10 years, and it’s putting Medicaid on a fiscally unsustainable path,” he said.
Daines, a Republican, says he’ll wait until he sees the text of the bill before deciding whether to support it.
Yet he generally supports repealing the ACA (“Obamacare”), saying it has made health insurance unaffordable for many people buying on the individual market and hasn’t reduced the cost of coverage or care. He also says he’s listening to Montanans, including those in health care, before deciding how to proceed.
Montana’s other U.S. senator, Democrat Jon Tester, told MTN News Thursday that Democrats have been locked out of Senate discussions on the bill – but that the concepts being pursued by the GOP are bad news for Montana and the rest of rural America.
“Let’s get input from everybody and try to construct a bill that will meet the needs of Americans,” he said. “And that’s certainly not happening right now. … Let’s keep the things from the old ACA that work and let’s fix the things in the ACA that are wrong.”
Republicans in the U.S. House passed the American Health Care Act on May 4, to repeal and replace “Obamacare.”
The Republican-controlled Senate is now working on its version of the repeal and could release it later this month. Daines said the bill could be on the Senate floor by July.
Key elements of the House bill include:
- Limiting and eventually scaling back federal funds that support expanded Medicaid, which has covered an additional 77,000 low-income Montanans.
- Abolishing the federal mandate to buy health insurance.
- Getting rid of means-tested federal subsidies that help individuals buy health insurance with replacing them with federal tax credits, tied to one’s age.
- Allowing states to decide whether they want to opt out of some mandates, such as requiring health insurance to cover a set of “essential benefits.”
- Providing funds for state-based “high risk pools” that would help support coverage for people with certain health conditions.
Daines said the Senate bill will take steps to “stabilize” the market for individual health-insurance policies, because insurers have been pulling out of these markets across the country, leaving consumers with little or no choices.
“We’re on a bit of a rescue mission right now to stabilize the current market, which is very unstable,” he said.
Details on those specific steps will be coming out soon, Daines said.
In Montana, three private insurers have served the individual market since the ACA took effect in 2013 – and premiums for many of those policies have increased more than 100 percent.
However, subsidies have also increased to offset some or all of the increases for the 85 percent of people getting the subsidy in Montana. Only about 8 percent of Montanans are buying coverage on the individual market.
The Senate bill, like the House bill, will move to tax credits instead of subsidies to help those buying individual coverage, Daines said. But it’s likely to use a person’s income to determine the amount of credit, instead of only one’s age, he said.
He also said he expects the Senate bill, like the House version, to allow removal of mandates on coverage, thus allowing “more flexibility to have consumer choice.”
“Letting the patient decide instead of the government, on what has to be in the plan, is a way to start some relief here in cost and to create some competition,” Daines said.
On Medicaid, the bill likely will have some type of per-capita federal payment for how many people are on the program, he said, including those newly covered by the expansion in Montana.
However, the amount of the payment for the able-bodied people covered by the expansion likely will be reduced, starting in 2021, Daines said. The program needs to be preserved for the truly needy and the disabled, he said.
Tester called the House repeal of the ACA “just a horrible bill,” and said from what he’s heard about the Senate version, it may not be much better.
Medicaid expansion should be preserved in its current form, he said, because it’s brought health coverage to more than 70,000 Montanans who couldn’t afford it and helped rural hospitals across the state.
A study released last month by the Montana Budget and Policy Center, a nonprofit group that supports the ACA, said half of the 77,000 Montanans covered by Medicaid expansion and three-fourths of those using subsidies for individual coverage live in rural areas.
Tester also said the main reason that individual markets are having problems is because the GOP-controlled Congress has either refused to consider any improvements to the ACA or taken action to undermine it.
“Talking points are great, and you can stand up and say that `death spiral’ talking point, but the fact that it’s going into a death spiral … is because Washington hasn’t done anything to fix it,” he said. “And in the end, you know who suffers? The rank-and-file people in the state of Montana, and it’s unacceptable.”