Senate Health Bill is Penny Wise, Pound Foolish
To borrow an observation, health care is complex. Central to our health outcomes is access to care. One type of access – financial access – is the type that the Affordable Care Act expanded for millions of Americans. That is what’s primarily at stake in the Senate’s new bill, says Kimberley Isett, an associate professor in the School of Public Policy at Georgia Tech.
Access to care is comprised of many things: Are there facilities to get care and providers to give it? Are there excessively long waits or distances to travel to receive care? And is there an available payer for care? Financial access is not sufficient to guarantee physical access to care, but it is necessary. There are several ways the current Senate Bill has an impact on access:
1. The combination of more than $800 billion in cuts to federal money, with spending caps to limit the federal financial liability, will force states to either make up the difference or cut services. The proposed Senate cuts exceed those passed by the House.
Result: 14 million people newly covered under the Affordable Care Act expansion may be cut from Medicaid.
2. Tax subsidies are cut and deductibles are likely to rise. This will price many individuals out of the new insurance markets.
Result: More people will be uninsured because they are too poor to afford the marketplace but “too rich” to qualify for Medicaid.
3. While people with pre-existing conditions will be able to get insurance, it won’t cover basic health care needs because of waivers allowed in the bill. Community rating is also in jeopardy. This requires insurers charge rates based on a population, not individual backgrounds so that sicker people aren’t charged more for insurance.
Result: People with known health care needs will be forced to pay more for less coverage. This will result in huge disparities in care and large premiums for those who are most unable to bear the burden.
The Senate bill would also decrease access to health care facilities because rural hospitals are already in jeopardy of closing. These hospitals serve a high percentage of the sickest and poorest among us who rely heavily on Medicaid. If Medicaid coverage shrinks, hospitals won’t get paid. If hospitals don’t get paid, they will be forced to close, leaving these rural populations without any realistic access to providers. This is already dire across the country, and the Senate bill would worsen the situation. An estimated 22 million individuals will be left without financial access to care by this bill.
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