West Virginia Sen. Joe Manchin, a Democrat, remains opposed to Senate Republicans’ newest plan to replace the Affordable Care Act released Thursday morning. Sen. Shelley Moore Capito, the state’s Republican senator, still isn’t saying where she stands.
The American Health Care Act, House Republicans’ plan to replace the ACA, narrowly passed the U.S. House of Representatives in May. West Virginia’s three Congressmen, all Republicans, voted for the bill.
Both Senate and House Republicans’ plans would eliminate the individual mandate.
Both plans also would substantially change how Medicaid is funded, resulting in a significant reduction of federal dollars allocated for West Virginia.
Both also would end Medicaid expansion in West Virginia. Medicaid expanded to cover people who make up to 138 percent of the federal poverty line in 2014. About 170,000 in West Virginia are covered by Medicaid expansion. Currently, the federal government pays about 90 percent of costs for the expansion population.
Under the House Republican plan, the federal government would pay a smaller proportion of costs after 2019. Under the Senate bill, the federal government would pay a smaller proportion of costs starting in 2021.
Capito released a statement:
“Over the course of the next several days, I will review the draft legislation released this morning, using several factors to evaluate whether it provides access to affordable health care for West Virginians, including those on the Medicaid expansion and those struggling with drug addiction.”
Department of Health and Human Resources Secretary Bill Crouch has previously said that “any change” to the federal matching rate “would create an unsustainable financial obligation for our state.”
The version of the bill released Thursday would decrease the federal matching rate to 85 percent in 2021, 80 percent in 2022, and 75 percent in 2023.
“You know the state’s budget as well as I do,” said Simon Haeder, an assistant professor in the Department of Political Science at West Virginia University. “We’re struggling as it is.”
National news outlets have reported that Capito was advocating for a seven-year phase down, instead of the three-year phase down proposed by the House. She was one of four senators who said they couldn’t support the House bill and wanted “stability” for the expansion population.
“I think the Republican playbook in the Senate is very similar to the playbook in the House,” Haeder, who researches health policy and health reform, said. “You come up with something that allows some people in peculiar positions like Senator Capito to say this is not working; we need to protect West Virginia. Then what happens is the majority leaders in the Senate will throw some bones to those individuals. I think right now it’s only $2 billion for opioid addiction. So I would guess what’s going to happen in a couple days when they make amendments, that’s going to go from 2 to 5 or 10 or some number that looks better but doesn’t scratch the surface of what needs to be done but allows people like Senator Capito to say ‘That’s why I can vote for it.’”
The bill contains $2 billion to address opioid addiction, as of now.
Haeder also said that “if you’re honest, in a state like West Virginia, any cut to Medicaid is a problem for the state, because we’re cutting everything else, and we’re really not going to turn the state around in the next one, two or three years. We’re not going to get all of these high-paying jobs all of a sudden. What you do is you very carefully choose your words, then you try to get something a little better for your state. None of this in here is good for West Virginia, and a lot of it is worse.”
The bill, like the House bill, makes significant changes to Medicaid funding that pre-date the Affordable Care Act, so that federal funding would no longer be based on services billed.
“That’s just taking the opportunity while you’re there and trying to back door some stuff that has nothing to do with the ACA itself,” Haeder said. “You didn’t run on the argument you needed to halve the Medicaid program.”
About 30 percent of West Virginia is covered by Medicaid.
Haeder also is concerned the bill hasn’t gone through committee hearings or been vetted by industry and advocacy groups.
“I think there is vast potential for unintended consequences,” he said.
Everyone contacted still was reviewing the 142-page bill, which was crafted behind closed doors.
“We’re looking at pieces of a pie but trying to connect all the dots right now is difficult,” said Joe Letnaunchyn, president and CEO of the West Virginia Hospital Association. “The bottom line is it’s going to be less dollars to providers for Medicaid recipients.”
The Congressional Budget Office has yet to score the bill, so it’s unclear how many people would lose coverage and what the fiscal impact would be.
“It’s going to have significant ramifications to coverage for individuals,” Letnaunchyn said. “Once you agree to that, the numbers don’t matter. That’s enough for me to know this is problematic.”
“If you reduce the number of people that are covered under the expansion, even if they go back to the traditional Medicaid program, it’s going to have an impact on them if you change the level of services that are provided,” he said. “It affects the entire population of West Virginia — not just those covered under Medicaid. That’s going to affect you, me and all the other taxpayers in West Virginia. It’s a much broader audience than just the Medicaid population.”
“If you look at what we went through this year, that will be nothing compared to what we might have to go through in future years with these changes,” he added, referring to the near state government shutdown over the state budget. “It’s not going to affect just the Medicaid population. It’s going to affect the entire citizen base of West Virginia because all the taxpayers could be adversely affected when we have to make changes to the Medicaid program as part of the budget.”
Manchin said “I agree with President [Donald] Trump that the House bill needed more heart, and it seems that the Senate bill needs more soul. Based on my initial review, the healthcare bill released by Republican leadership today appears to be as bad of a deal for West Virginia as the House bill. It maintains severe cuts to Medicaid, raises costs for seniors, and denies coverage for those who desperately need substance abuse treatment. It also gives a tax break to 11,000 of the wealthiest West Virginians without doing anything for the other 920,000 taxpayers — and it pays for these cuts on the backs of our most vulnerable neighbors.”
DHHR and State Insurance Commissioner Allan McVey had not responded to a request as of Thursday evening. McVey’s spokeswoman said they still were reviewing the bill.
West Virginians for Affordable Health Care released a statement calling the bill “as mean as the House bill,” a reference to a comment by President Donald Trump about the House’s proposed legislation.
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