After weeks of privately drafting legislation, Majority Leader Mitch McConnell solicited only GOP feedback. Those discussions reveal intent to completely overhaul Medicaid financing with an unprecedented cap on federal spending. This goes beyond rolling back Medicaid expansion. The potential compromise appears to be a gradual (three to seven years) rather than abrupt decrease of Medicaid coverage. It is clear that millions of Americans will lose health care coverage. A recent Quinnipiac poll found 74 percent of voters oppose cutting federal funding for Medicaid.
The emerging bill allows states to waive the Affordable Care Act's essential health benefits. The change would allow insurers to exclude treatment for more expensive conditions, causing significant or prohibitive cost increases for those requiring care. When the proposed American Health Care Act was evaluated by the CBO, they suggested that the most likely services to be excluded would be maternity care, mental health and substance abuse treatment, and rehabilitative care.
As we move into this critical decision period, we need to seek facts that clarify how this bill will affect us as well as our fellow citizens. The 2009 CBO report of the ACA was roundly rejected by Republicans while an independent review by the Commonwealth Fund found it quite accurate. The forthcoming CBO estimates on the Senate bill should be respected and used to insist that we not return to a state of national disgrace by failing to provide health care for our most vulnerable citizens. In Sen. Orrin Hatch's recent town hall, he claimed that under the ACA health care costs had increased by 100 percent. The truth is that from 2010 to 2015, per capita healthcare spending increased 3.6 percent, growing more slowly than in other comparable countries. We must now rigorously seek the truth to secure the kind of country we want to be part of and to avoid disastrous consequences for our society.
Hubert Humphrey once said, "The moral test of government is how that government treats those who are in the dawn of life, the children; those who are in the twilight of life, the elderly; and those who are in the shadows of life, the sick, the needy and the handicapped." Now is the time to define the moral foundation that health care defines for our country.
Julie Day, M.D., is the medical director for quality improvement and population health for the Community Physician Group at the University of Utah.