Providers say replace, payers still waiting for CSR stability, as McConnell scraps Senate bill

Senate Majority Leader Mitch McConnell is calling for a vote to repeal of the Affordable Care Act, with a two-year delay on implementation, after pulling the healthcare bill for lack of votes.

McConnell said Tuesday "I regret that the effort to repeal and immediately replace the failures of Obamacare will not be successful."

America's Essential Hospitals said a two-year delay is not the answer to ensuring millions retain healthcare coverage.

"We have little confidence a plan will exist to save an estimated 18 million people from losing insurance within a year of full repeal," said Bruce Siegel, president and CEO of America's Essential Hospitals. "We urge the Senate to return to the drawing board and consider more limited, targeted solutions to our healthcare challenges."

The American Hospital Association also said that repeal without any effort to replace would leave millions of patients at risk.

Rick Pollack, president and CEO of the American Hospital Association said, "Throughout this debate, we have remained consistent in our call: Protect care for patients. This is grounded in the belief that coverage must be preserved for all who currently have it. Our hope is that the Senate will use this opportunity to regroup and work in a bipartisan manner to make the much-needed repairs and refinements, creating a health care system that can stand the test of time. We ask Congress to extend the Children's Health Insurance Program and vital rural health programs and stabilize the Health Insurance Marketplaces by funding the cost-sharing reduction payments."

Providers have said they face rising uncompensated care costs if the ACA is repealed without a similar replacement plan. Two Republican plans out of the House and Senate would have increased the number of uninsured Americans by at least 22 million over ten years, the Congressional Budget Office has estimated.

Health insurers are still looking for a federal guarantee of the continuation of ACA cost-sharing reduction payments that allows them to reduced deductible and out-of-pocket costs for lower-income consumers.

[Also: Revised Senate bill keeps Cruz amendment for slimmed down coverage]

Before McConnell's announcement to withdraw the Senate bill, the GOP had already lost two Republican votes from Senators Susan Collins of Maine and Rand Paul of Kentucky. It could not afford to lose more but then Senators Mike Lee of Utah and Jerry Moran of Kansas said they could not support the current bill.

"We will now try a different way to bring the American people relief from Obamacare," McConnell said Tuesday. "I think we owe them at least that much. In the coming days the Senate will take up and vote on a repeal of Obamacare combined with a stable two-year transition period as we work toward patient-centered healthcare."

Two years ago, Republicans tried to repeal the Affordable Care Act through a reconciliation bill, that was vetoed by President Obama.

McConnell said, "Trump will sign it now."

[Also: Healthcare organizations criticize revised Senate bill for Medicaid, coverage cuts]

"So, in the coming days, the Senate will vote to take up the House bill with the first amendment in order being what a majority in the Senate already supported in 2015 and that was vetoed by then-President Obama: a repeal of Obamacare with a two-year delay to provide for a stable transition period to a patient-centered healthcare system that gives Americans access to quality, affordable care," McConnell said by statement.

In 2015, the Congressional Budget Office estimated that repeal of the ACA would increase federal deficits by $137 to $353 billion over ten years, while other factors would reduce the deficit by $216 billion.

The CBO at that time estimated that repeal would increase the number of uninsured, nonelderly adults by about 24 million through 2025.

Insurers have been looking for the stable transition called for by McConnell, in the continuation of cost-sharing reduction payments. Numerous ACA insurers have left the market over financial losses and a lack of guarantee that the CSR payments would continue.

The Senate bill, the Better Care Reconciliation Act killed by McConnell, had a provision to continue the CSRs for two years.

[Also: Lack of CSRs one reason Anthem BCBS to leave ACA market in Ohio]

The Blue Cross Blue Shield Association made clear in a statement Tuesday the necessity of the administration to continue funding the CSRs payments to insurers.

"With open enrollment for 2018 only three months away, our members and all Americans need the certainty and security of knowing coverage will be available and affordable for them," said Justine Handelman, senior vice president, Office of Policy and Representation for BCBS Association. "To achieve that, we have consistently urged that there be immediate, certain funding for the cost-sharing reduction program, which helps those most in need with out-of-pocket costs when they access medical care, and other actions to stabilize the market including dedicated funding to care for those with significant medical needs. We support a path that allows federal and state lawmakers to stabilize insurance markets in the short term, while working toward permanent solutions that will provide people with the high-quality, affordable healthcare they need."

America's Health Insurance Plans, which recently sent a letter to the Senate opposing the bill's amendment to allow for two types of coverage, said it remained committed to working with the administration to ensure short-term stability and the long-term improvement of healthcare.

"Every American deserves affordable coverage and access to high-quality care," said Kristine Grow, senior vice president of communications for AHIP.  "We support solutions that deliver affordable choices while improving and protecting the health of all patients and the financial well-being of all consumers."

America's Essential Hospitals said it welcomed the Senate leaders' decision to pull back the Better Care Reconciliation Act of 2017.
"We hope lawmakers seize on this opportunity to bring all stakeholders to the table and develop a plan to protect coverage for everyone--especially those in greatest need," Siegel said. "The newly surfaced plan to repeal the Affordable Care Act's core provisions with a two-year delay is not the way to protect coverage and almost certainly would jeopardize care for people who face financial hardships. The repeal-and-delay strategy would leave millions of lives in limbo and create uncertainty that would destabilize insurance markets and paralyze hospitals and other providers."
 
American Medical Association President David O. Barbe, MD, said, "The health reform debate is by no means over. Congress must begin a collaborative process that produces a bipartisan approach to improve health care in our country. The status quo is unacceptable. Near-term action is needed to stabilize the individual/nongroup health insurance marketplace. In the long term, stakeholders and policymakers need to address the unsustainable trends in health care costs while achieving meaningful, affordable coverage for all Americans."

Republican Senator Susan Collins has called on members of her party to work with Democrats to fix the ACA.

Ways and Means Committee Ranking Member Richard Neal of Massachusetts said, "... Republicans should listen to the overwhelming majority of Americans who want Republicans to join Democrats in working on bipartisan health care solutions that build on the Affordable Care Act's successes in an open and transparent process."

Twitter: @SusanJMorse