After Senate Republican leaders announced Tuesday that no vote on their health reform repeal bill would take place this week, Sen. Shelley Moore Capito, R-W.Va., announced Tuesday afternoon she does not support the current version of the GOP plan to replace the Affordable Care Act.
Capito’s office sent a joint statement with Sen. Rob Portman, R-Ohio, after national news outlets began reporting Senate Majority Leader Mitch McConnell, R.-Ky., had said no vote would take place on the Better Care Reconciliation Act until after the July 4 recess.
With 52 Republican senators, GOP leaders can only afford to lose two votes and still pass the bill without Democratic support. Five other Republican senators already had publicly said they couldn’t support the bill, which would make deep cuts to Medicaid, repeal ACA taxes on the wealthy and its annual fee on insurance providers, and reduce subsidies for nongroup health insurance, among other provisions.
“I came to Washington to make the lives of West Virginians better,” Capito said in a statement. “Throughout this debate, I have said that I will only support a bill that provides access to affordable health care coverage for West Virginians, including those on Medicaid and those struggling with drug addiction. In West Virginia, Obamacare has led to skyrocketing premiums, co-pays, and deductibles for families and small businesses. Patients have fewer choices in doctors and hospitals as networks shrink and plans become more restrictive.
“I have consistently looked for opportunities to improve this broken law, including co-sponsoring the Patient Freedom Act of 2017 earlier this year. I continue to believe we must repair what can be fixed, scrap what is not working, and create a better health care reality for West Virginians. At the same time, West Virginia has the largest Medicaid population in the country. I recognize that many West Virginians rely on health coverage and access to substance abuse treatment because of my state’s decision to expand coverage through Medicaid. I have studied the draft legislation and CBO analysis to understand its impact on West Virginians. As drafted, this bill will not ensure access to affordable health care in West Virginia, does not do enough to combat the opioid epidemic that is devastating my state, cuts traditional Medicaid too deeply, and harms rural health care providers.”
West Virginia was one of 31 states that expanded Medicaid to cover people who make up to 138 percent of the federal poverty level, after the Affordable Care Act was enacted. About 170,000 West Virginians have coverage through the expansion. State officials have said about 50,000 people who have coverage through Medicaid expansion had substance abuse diagnoses in 2016.
The bill would decrease the federal matching rate, which is currently about 90 percent, for the expansion population. It would decrease to 85 percent in 2021, 80 percent in 2022 and 75 percent in 2023. Department of Health and Human Resources Secretary Bill Crouch already has said that any reduction in the federal matching rate would “create an unsustainable financial obligation” for the state.
The bill also would cut Medicaid funding for those not covered by the expansion. The Congressional Budget Office estimated that the current version of the bill would cut Medicaid by $772 billion over 10 years, based mainly on ending the extra funding for states that expanded Medicaid and setting per-capita based caps on Medicaid payments to states. The CBO estimated that 15 million fewer people would have Medicaid in 10 years, compared to 14 million fewer under the House version of the bill.
Capito previously had said she was reviewing and working to improve the proposed legislation.
“As drafted, the Senate health care bill is not the right fix for West Virginia, and I cannot support it,” she said Tuesday. “My concerns will need to be addressed going forward.”
The CBO announced on Monday that it estimated the bill would increase the number of people without health insurance by 22 million by 2026. The House-passed version of the bill, the American Health Care Act, would have increased the number of people without insurance over the same period by an estimated 23 million. All three representatives of West Virginia in the U.S. House of Representatives voted for that bill.
The Senate bill also would reduce the federal deficit over the same period by $321 billion, according to the CBO estimate. Those savings “would be partially offset by the effects of other changes to the ACA’s provisions dealing with insurance coverage,” the CBO stated. “The largest increases in deficits would come from repealing or modifying tax provisions in the ACA that are not directly related to health insurance coverage, including repealing a surtax on net investment income and repealing annual fees imposed on health insurers.”
The bill would end the employer mandate, as well as the individual mandate. However, it also would require insurers to impose a six-month waiting period before coverage starts for people who enroll in the nongroup market if they have been uninsured for more than 63 days within the past year.
Portman and Capito were two of the senators who, in March, sent a letter to McConnell saying they could not support a bill that did not provide “stability for Medicaid expansion populations or flexibility for states.”
Portman also pointed to the ongoing opioid crisis.
“For months, I have engaged with my colleagues on solutions that I believe are necessary to ensure that we improve our health care system and better combat this opioid epidemic,” he said. “Unfortunately, the Senate draft falls short and therefore I cannot support it in its current form. In the days and weeks ahead, I’m committed to continue talking with my colleagues about how we can fix the serious problems in our health care system while protecting Ohio’s most vulnerable citizens.”