December 14, 2017
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Influential groups representing hospitals, doctors come out against ACA replacement plan

By Sean Sullivan, Elise Viebeck, Mike DeBonis and Juliet Eilperin, The Washington Post

A constellation of influential groups representing the nation’s hospitals and physicians came out Wednesday against a House Republican proposal to overhaul the Affordable Care Act, marking the latest round of setbacks to the controversial plan.

Seven groups representing the nation’s hospitals, health systems and medical colleges collectively added their “significant concerns” to the growing opposition, focusing on the prospect of sharply lower numbers of insured Americans if the Republicans’ plans were to become law. Separately, the American Medical Association, a powerful lobbying group for physicians, rejected the bill for the same reason.

The new round of opposition underscored the challenge that proponents of the bill, known as the American Health Care Act, are facing. It came as the White House and House Republican leaders moved to try to overcome the surge of hostility to the bill from conservatives, Democrats and industry groups.

In a letter to Congress, the hospital groups, which included the American Hospital Association, wrote, “Our assessment of this legislation as currently drafted is that it is likely to result in a substantial reduction in the number of Americans able to buy affordable health insurance or maintain coverage under the Medicaid program.”

They said they anticipated “tremendous instability for those seeking affordable coverage.”

The groups also addressed the proposed changes to Medicaid, warning that they would mean lost coverage and funding cuts for a program charged with caring for vulnerable children, elderly and disabled Americans.

The cuts forecast to providers, in combination with reduced coverage, would “reduce our ability to provide essential care to those newly uninsured and those without adequate insurance,” their letter continued.

AMA chief executive James Madara, a doctor, wrote in a letter released Wednesday: “We cannot support the AHCA as drafted because of the expected decline in health insurance coverage and the potential harm it would cause to vulnerable patient populations.”

The list of organizations opposing the measure has grown quickly since the bill was unveiled on Monday. The AARP came out against it Tuesday.

White House press secretary Sean Spicer said Wednesday that administration officials, including President Trump, are engaged in a “full-court press” to sell the House GOP health care bill through local radio and television interviews and meetings with stakeholders.

On Capitol Hill, where a pair of House committees started trying to advance the legislation, Speaker Paul Ryan, R-Wisconsin, expressed confidence the bill would eventually pass, even though some House GOP members have railed against it.

Trump will host a group of conservative leaders at the White House on Wednesday night to discuss their concerns, Spicer said — the second night in a row Trump has huddled with players in the debate to discuss strategy.

At the same time, Spicer sought to pre-emptively discredit the nonpartisan budget analyst that is preparing to report on how much the bill will add to the federal deficit.

Next week, the Congressional Budget Office also will forecast how many people could lose coverage if the measure is enacted, an area where the Republican plan is vulnerable.

“If you’re looking to the CBO for accuracy, you’re looking in the wrong place,” Spicer said, accusing the office of mistakes in its forecasts about the Affordable Care Act.

Ryan described the proposal as a “conservative wish list” that would deliver on years of GOP campaign promises to reform the nation’s health care system.

“This is the covenant we made with the American people when we ran on a repeal-and-replace plan in 2016,” he said at a news conference Wednesday on Capitol Hill.

“I have no doubt we’ll pass this, because we’re going to keep our promises,” he said.

The developments highlighted the high stakes confronting Ryan as that committee work got underway on Wednesday. Republican leaders face stiff opposition to their proposal from both the left and the right, as Democrats decry the plan’s expected toll on vulnerable populations, and conservative Republicans say it would not go far enough in pulling back elements of the ACA. Moderate Republicans and major stakeholders from the health care industry, including hospitals, also have pushed back on the plan.

The most imminent and serious threat is criticism from conservative lawmakers and advocacy groups, such as Heritage Action for America, FreedomWorks and the Club for Growth, which hold significant power to produce “no” votes within the right flank of Ryan’s conference. The speaker can lose only 21 Republican votes if the American Health Care Act is to pass, and opponents are promising to use that leverage to force changes to the bill.

To reporters, Ryan played down the conservative rebellion, describing it as a temporary reaction from Republicans who have never held office under unified GOP control.

“We’re going through the inevitable growing pains of being an opposition party to being a governing party,” he said. “It’s a new feel, a new system for people.”

Ryan also sought to mute complaints that the measure was released without a cost estimate from the Congressional Budget Office, calling the situation “very common” and vowing the numbers would be available next week.

“This is a monumental, exciting conservative reform,” he said of the plan in a bid to woo critics on the right. “I’ve been working on this for 20 years. This is exciting. This is what we’ve been dreaming about doing.”

Ryan does have one major ally in his corner — Trump, who wants the House bill approved quickly and without significant changes and has warned that not doing so will result in trouble for Republicans at the ballot box.

The White House has already spent several days targeting skeptical conservatives in a behind-the-scenes “charm offensive,” said Sen. Rand Paul, R-Kentucky, who has emerged as the bill’s chief skeptic.

“Every conservative that’s come out publicly opposed to this has been called by the White House and is being cajoled and wooed by the White House to give in,” Paul said during an interview with MSNBC’s “Morning Joe” on Wednesday.

“But if conservatives stick together . . . we will have a force and a negotiation,” he said. “Because I don’t think they have the numbers to pass this at this point.”

Trump specifically called out Paul with a tweet Tuesday evening: “I feel sure that my friend @RandPaul will come along with the new and great health care program because he knows Obamacare is a disaster!”

Meanwhile, by midday Wednesday, the two House committees working on the bill were experiencing the kinds of partisan skirmishes expected to dominate the process over the next several weeks.

In a meeting of the House Ways and Means Committee, Democrats moved immediately to lambaste the bill and the process that produced it.

Rep. Lloyd Doggett, D-Texas, offered a motion to delay the hearing for one week to allow for further hearings on the bill and to examine the CBO report. The motion was voted down on a straight party-line vote.

“Health care is too important, it impacts too many lives, to have a health care bill jammed though in the same manner as President Trump’s immigration order,” Doggett said. “What this bill needs is some extreme vetting.”

In the House Energy and Commerce Committee, Democrats engaged in another procedural protest as they questioned why the majority had constrained most members to one-minute speeches, rather than three-minute speeches.

In a sign of how strained relations between the two parties have become, New Jersey Rep. Frank Pallone Jr., the panel’s top Democrat, repeatedly sparred with Chairman Greg Walden, R-Oregon, over parliamentary procedure once the House bill was called up for consideration.

As Pallone peppered Walden with questions and said Democrats were prepared to offer roughly 100 amendments, the Oregon Republican replied in an exasperated tone. “We’ll get through this,” he said. “Let’s all just settle down.”

But Democrats continued to press their objections, demanding that the committee clerk read the revised legislative proposal word-for-word rather than skip that step for the sake of time, as is customary. Walden estimated that process alone would take two hours.

The lack of a CBO score remained a flashpoint in the committee hearings, with lawmakers saying they could not properly assess the bill without forecasts about its budget and insurance impact.

Earlier in the day, a House Republican aide pushed back on this criticism in an email to reporters, writing that the score “is not necessary” and that the leadership “will have a score showing that we’ve hit our targets before the bill goes to the floor.”

White House Budget Director Mick Mulvaney also played down worries about the missing cost estimate, predicting it would arrive Monday and noting that because the health care plan is being considered under a special budget procedure known as reconciliation, it cannot increase the federal deficit after a period of 10 years.

“We all know [the bill] is going to score positive in helping out the deficit, to spending less money, another thing that conservatives should be supportive of,” Mulvaney said on MSNBC. “So I hear all the talk about the CBO score. The only question about the CBO: Is it going to be really good or is it going to be great when that number finally comes out?”

Ryan has outlined three phases in which health care reform would be achieved: first, via reconciliation, of which the current measures are a part; then, through regulations at the Department of Health and Human Services; and finally, the passage of other bills that would need more backing and could include the ability to buy insurance across state lines, a priority for conservatives.

Republicans in the Senate have complained that the process is still moving too quickly.

“I don’t think we need to introduce legislation on Monday and have one chance to amend it on Wednesday,” Sen. Tom Cotton (Arkansas) said on “Morning Joe,” referring to the House committee hearings.

“I want to get it right. I don’t want to get it fast. And the Senate certainly will not just be jammed with whatever the House sends over here,” he said.

Several Republican senators complained Tuesday afternoon that Trump does not fully grasp the Senate’s slower pace or its concerns.

“If [passage] takes months or a year, so be it,” said one Republican senator, who spoke on the condition of anonymity because negotiations are ongoing.

The senators said there is confusion about who is managing the process and which administration figures, if any, have the power to sway Trump.

 


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