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One GOP proposal would fund high risk pools with $25 billion
over 10 years. They would be open to everyone who needs them,
and would include a cap on premiums to keep them affordable.
But Dr. Snyder said $25 billion won't cover the tab. "I think what
we've observed is that that figure probably is an underestimate of
what it (a high risk pool) would cost to implement. Realistically, it
could be considerably higher than that."
The Medicaid Idea


CBO: 24 Million Would Lose
Coverage in GOP Plan
The non-partisan Congressional Budget Office (CBO) reports
that under the House Republican proposal, the number
of Americans without health insurance would grow by 24
million by the year 2026. That would bring the total number
of uninsured in that year to 52 million.

President Trump and Republican leaders in Congress would
turn the federally-mandated Medicaid program into block grants
that the states would spend on health care. Marc Stier, director of
the Pennsylvania Budget and Policy Center, thinks there's only one
reason Republicans in Congress find block grants attractive. "They
want to reduce spending, which doesn't seem to us to recognize that
current spending is needed to get people the health care they need.
And going after Medicaid, which in many ways is the most efficient
and least costly form of health care we deliver in this country, is
kind of bizarre."

The report, released on March 13, rattled moderate
Republicans in both the House and the Senate, who say they
will not support a bill that leaves a significant number of
people uninsured. The rise in uninsured would also contradict
President Trump's promise that everyone would be covered
under a new plan.

Dr. Snyder said block grants could lead to people losing their
health coverage. "One of the concerns is that they (block grants) will
result in lower levels of coverage, either in the number of people and/
or the actual benefits." He said talk about block grants is speculation,
of course, until Congress decides how much money to put in them.

Health and Human Services Secretary Tom Price disputes
the CBO report, arguing that it does not factor in steps his
agency would take to drive down insurance costs, and lure
more people into buying policies.

"It all depends on how big the block grant is," Pauly said. "If
you make it small, it would be bad for the poor population. If they
were financed in a generous way, then it would be up to the states
to decide how generous they would be to their poor population."

The CBO reports that the Republican proposal would cut
the federal deficit by $337 billion in 10 years, by squeezing
$880 billion from federal Medicaid spending during that time.
Much of that money is now being used to help low income
individuals pay for health insurance.

Meehan argues that block grants, if done right, would help
control costs while still getting care to the people who need it. "The
governors are asking to be given the opportunity to use the system
more effectively to control the quality and provision of care. If we
do it right we can operate within the cost structure. We've seen some
success in certain states that do that."
It's Complicated
All these plans have varying degrees of support in Congress, but
it has become increasingly clear to Republican leaders that getting
repeal and replace bills through the House and Senate will be very
hard to do. Before he gave his address to the joint session of Congress,
President Trump told a meeting of CEOs, that morning, that he
now realizes that health care is "an unbelievably complex subject.
Nobody knew health care could be so complicated."
Critics say the new president has clearly just started paying
attention to this monster. Former House Speaker John Boehner
recently said that "in the 25 years I served in the United States
Congress, Republicans never, ever, one time agreed on what a health
care proposal should look like. Not once." He predicts that in the
end Congress will "fix the (ACA) flaws and put a more conservative
box around it."
Dr. Snyder says that despite the messy debate over the Affordable
Care Act, good things have grown out of it. "I'm having conversations
with providers today that would've never happened three, four, or
five years ago. There's a new willingness to open up and talk about
how we can work together."

Democrats said the CBO score confirmed predictions that
the GOP bill would be a catastrophe for millions of Americans.

The AMA Opposes the Republican
Health Care Plan
The American Medical Association says it cannot support
the GOP plan "because of the expected decline in health
insurance coverage and the potential harm it would cause
to vulnerable patient populations."
The AMA likes the idea of tax credits to help individuals
buy health insurance, but opposes the way the
Republican bill has designed them, because they are tied
to age, rather than income. Tying the credits to income,
the AMA argues, would help a greater number of people
and be a more efficient use of tax dollars.
The AMA also says rolling back Medicaid expansion
is a bad idea. "Medicaid expansion has proven highly
successful in providing coverage for lower income
The AMA concluded that the bill must ensure that low
and moderate income Americans can secure affordable
coverage. "We urge you to do all that is possible to ensure
that those who are currently covered do not become

Spring 2017 : Philadelphia Medicine 27


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