A Hard-To-Swallow Bill

Fourteen million Americans would lose coverage next year under the American Health Care Act - the House Republican bill that seeks to replace "Obamacare" - and that number would rise to 24 million by 2026, an analysis by the nonpartisan Congressional Budget Office found. U.S. Health Secretary Tom Price called the CBO's appraisal "simply wrong." Congressman Lloyd Smucker, of Lancaster County, joined the majority in a 19-17 vote in favor of the GOP health care bill in the U.S. House Budget Committee on Thursday. Three Republican members of the Freedom Caucus joined Democrats in voting against the AHCA; it goes next to the House Rules Committee.

You need either a legal degree or a medical degree, or maybe both, to fully understand the intricacies of the American Health Care Act.

It may be nearly 740 pages shorter than the Affordable Care Act, or what became known as "Obamacare," but as President Donald Trump recently noted, health care is "an unbelievably complex subject."

One thing we know for sure: People are anxious about what the AHCA might mean for them. That anxiety is threaded through our letters pages.

More than 716,000 Pennsylvanians secured health insurance under "Obamacare's" Medicaid expansion in the commonwealth. Department of Human Services Secretary Ted Dallas says that "124,000 Pennsylvanians have received life-saving drug and alcohol treatment services because of the Medicaid expansion."

Dallas worries that repealing "Obamacare" could mean that the 6.4 percent uninsured rate in Pennsylvania and the 4.1 percent uninsured rate for children - both the lowest in the state's history - could nearly double.

The AHCA also would fundamentally restructure Medicaid so that Medicaid funding would go to states in per-capita block grants.

In the next budget year, under the current system, Pennsylvania would pay just 5 percent of Medicaid funding, while the federal government would pay 95 percent - or some $2.2 billion.

Under the AHCA, Pennsylvania would need to cover all of that $2.2 billion by 2020. For a state that already has an estimated $3 billion structural deficit, that's going to be impossible.

In a couple of years, 1 in 4 Pennsylvanians will be a senior citizen. There simply won't be enough funding to cover their needs and the needs of people - children and adults - with disabilities.

"We will have to start making awful decisions about whether we're going to serve seniors or people with disabilities," Dallas says. "Do we start waiting lists in every category? Play Solomon and pick one category of people over another?"

The AARP has similar worries. As it noted in a statement released last week, the Medicaid cuts in the GOP health care bill "could impact people of all ages and put at risk the health and safety of 17.4 million children and adults with disabilities and seniors by eliminating much-needed services that allow individuals to live independently in their homes and communities."

On Sunday, The Philadelphia Inquirer profiled a 34-year-old Philly man who was struck by a car in 2001 and was left a paraplegic. He is able to live independently in an apartment because part-time attendants help him into his wheelchair in the morning and stay with him at night. His aides are paid for with Medicaid funds. He worries that under the AHCA, he won't be able to keep them.

The AHCA's Medicaid restructuring also would have serious implications for students with disabilities, John George, of Lititz, pointed out in a Sunday LNP letter to the editor.

George wrote that Pennsylvania schools currently receive approximately $143 million in Medicaid funding to cover an array of needs, including early intervention services for children ages 3-5; nursing services for children with disabling conditions; mental and behavioral health services; and speech, occupational and physical therapy.

"Currently, Medicaid funding enables schools to provide these services based on the unique needs of each child with a disability," George wrote. "Under the Republican plan, funding for each child would be fixed, regardless of the severity of his or her disability, the type of service, or the amount of service needed."

Unfortunately, there is nothing fixed about the needs of people with disabilities - they change with time and circumstances and health status. Any replacement for "Obamacare" ought to accommodate this reality.

For understandable reasons, the AHCA bill is drawing fire from both Republicans and Democrats. In a Fox News interview Wednesday night, Trump acknowledged to Tucker Carlson that the bill, as written, would hurt the very people who voted for him. "It's very preliminary," the president said, noting that the bill was "going to be negotiated" in the Senate.

But Republican Sen. Tom Cotton of Arkansas told ABC's George Stephanopoulos that there's no point in sending the bill, as currently written, to the Senate.

"We should take a pause, try to solve as many of the problems on both Medicaid and the individual insurance market in this bill in the House and then allow the Senate to take its work up," Cotton said. "The bill probably can be fixed, but it's going to take a lot of carpentry on that framework."

This seems like a sensible prescription to us, one we'd urge readers to share with their representatives in Congress.

We understand that Trump and other lawmakers promised voters they would repeal and replace "Obamacare." But in their quest to do so, they ought to be mindful of the oath physicians take: "First, do no harm."