Senate struggle over Medicaid cuts threatens progress on Trump’s big bill
Washington – An unstable key problem of stopping progress on the major bill of President Donald Trump at Congress is particularly intimidating: how to reduce billions of health care without harming Americans or hospitals and others who provide care?
Republicans find it difficult to design a solution to the problem of health care that their package has created. Estimates already say that 10.9 million additional people would be without health coverage as part of the version adopted by the bill in the bill. GOP senators have proposed stronger discounts, which, according to some, goes too far.
“The Cups of the Senate in Medicaid are much deeper than the cuts of the room, and I think it is problematic,” said the Susan Collins of Maine’s Gop Senator.
The senators met behind closed doors and with officials of the Trump administration while they rush to complete the major bill before the deadline of the president of the July 4. A large part of the package, with its tax relief and reinforced border security expenses, is essentially written. But the size and scope of health care cuts are among the most difficult problems.
This recalls the summer during Trump’s first term in 2017, when the Republicans found it difficult to keep their campaign promise to “repeal and replace” the affordable care law, or Obamacare, only to see the explosion of the GOP on the prospect that the Americans lose the health coverage. This legislation collapsed when she is then known. John McCain launched a vote on the help.
The head of the majority of the Senate, John Thune, is determined to avoid this result, by firing it on the calendar and in advance with the vote expected by the end of the week.
“It’s a good bill and it will be great for our country,” said Thune on Wednesday, defending its potential to trigger economic growth and put money in people’s pockets.
The changes to federal health care programs, in particular Medicaid, should always become a centerpiece of the GOP package, a way to compensate for the costs of the supply of tax alternatives for millions of Americans. Without action of the congress, taxes would increase next year when the current tax law would expire.
The bill adopted by the Chamber carried out some 1.5 billion of dollars of savings overall, a large part of it from changes in health care. The Medicaid program has widened considerably over the 15 years since Obamacare has become the law and now serves some 80 million Americans. Republicans say it is far too high, and they want to reduce the program to a smaller size mainly covering the poorest women and children.
The Democrat Manager of Hakeem Jeffries said the Republicans “try to withdraw health care from tens of millions of Americans”. Democrats are uniformly opposed to what they call the “great ugly bill”.
A large part of the healthcare cost savings would come from new 80 -hour work requirements in a month for those who receive Medicaid services, even if most beneficiaries are already working.
But another provision, the so-called supplier taxes that almost all states impose to a certain extent on hospitals and others who serve Medicaid patients, arouses a particular concern for the potential reductions of rural hospitals.
Senator Josh Hawley, R-MO., Said several senators had spoke on Wednesday during a private meeting indicating that they were not yet ready to start voting. “It will depend if we disembark the plane of rural hospitals,” he said.
States impose taxes as a means of helping to finance Medicaid, largely by stimulating the reimbursements they receive from the federal government. Critics denounce the system as a type of “whitening”, but almost all states except Alaska use it to help provide health care coverage.
The bill adopted by the Chamber freezed the taxes of providers at the current levels, while the Senate proposal goes further by reducing the tax that certain states are able to impose.
“I know that the states are dependent on it,” said senator Roger Marshall, R-Kan. But he added: “Obviously, the service tax must disappear.”
But a number of GOP senators, and hospitals and other medical suppliers of their states, raise great concerns that tax changes for the supplier decimate rural hospitals.
In a plea for legislators, the American Hospital Association declared that the cuts will not only affect those who obtain health coverage through Medicaid, but that emergency rooms “as they will become the family doctor to millions of newly not insured people”.
“And worse, some hospitals, in particular those of rural communities, may be forced to close completely,” said Rick Pollack, president and chief executive officer of the hospital group.
The Catholic Health Association of the United States noted in its own letter that Medicaid offers health insurance coverage for one in five and almost half of all children.
“The modifications proposed in Medicaid would have devastating consequences, in particular for those of small cities and rural communities, where Medicaid is often the main source of coverage of health care,” said Sister Mary Haddad, president and chief executive officer.
Trying to ingest a correction to the problem, the senators plan to create a rural hospital fund to help compensate for the lost money from Medicaid.
GOP senators have distributed a proposal to pay $ 15 billion to establish a new rural hospital fund. But several senators said it was too high, while others said it was insufficient. Collins proposed that the fund be set at $ 100 billion.
“It will not be so big, but there will be a fund,” said Thune.
Hawley, who was among the most frank on health care cuts, said he was interested in the rural hospital fund, but has to know more about how it would work.
He also expressed concerns about a new co-payment of $ 35 per service which could be invoiced to those of Medicaid, which is both in the versions of the Chamber and the Senate of the bill.
“Obtaining the fund is good. It’s important, one step forward,” said Hawley. But he asked, “How does the fund really distribute money?”
A new analysis of the Council of Economic Advisers of the White House estimates that the package would lead to up to 2.3 billions of dollars reduction of the deficit over 10 years, a clearly different assessment of other analyzes. On the other hand, the dynamic analysis of the congress budget of the congress of Congress not in favor of the measure contained in the Chamber estimates an increase in deficits of 2.8 billions of dollars during the next decade.
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The editors of the Associated Press Kevin Freking, Mary Clare Jalonick, Joey Cappelletti and Fatima Hussein contributed to this story.
