North country health experts blast Senate GOP health care plan

June 25--Tweet

WATERTOWN -- The Senate GOP's health care bill has left some local health officials once again balking at the Republican Party's crusade to undo the Affordable Care Act and cut Medicaid spending.

Structurally similar to its House counterpart, the American Health Care Act, which was passed in early May, the Senate bill unveiled Thursday makes several key adjustments.

Like the AHCA, the Senate bill would eliminate individual and employer insurance mandates, phase out federal funding for the Affordable Care Act's Medicaid expansion and cap the program's spending, allow people under 26 years old to stay on their parents' insurance, and would charge the oldest Americans under 65 five times more than young people for coverage.

Unlike the AHCA, in this version's cuts to Medicaid are deeper, ACA taxes on the wealthy would be repealed even further, insurance subsidies for individuals to buy coverage would be based on income rather than age, and no longer require Medicaid to cover mental health after 2019.

River Hospital CEO Ben Moore III fears the outlined cuts to Medicaid could cripple the hospital's ability to provide many of its services. He says 56 percent of the hospital's outpatient clients are insured by some form of coverage made available by the ACA.

"Any cut is going to be severe, It's a very concerning time," Mr. Moore said. River Hospital currently provides all outpatient services at a financial loss; the strain of further loss of Medicaid funding may lead to loss of services. "We know something negative is going to happen but we don't know how bad and what cuts we will have to make. We will have to wait and do our best to adapt. I'm very disappointed it looks like it's going in this direction," Mr. Moore said.

Administrators at Samaritan Medical Center in Watertown and at Carthage Area Hospital declined to comment on the bill's potential impacts, with Samaritan spokeswoman Krista A. Kittle calling it "too early to speculate."

New York state's Democratic senators, Charles E. Schumer and Kirsten E. Gillibrand, blasted the bill after it was unveiled Thursday, with Sen. Schumer calling it a "wolf in sheep's clothing."

Sen. Gillibrand particularly criticized the bill's phaseout of Medicaid's expansions.

"The cuts to Medicaid in particular are galling," she said in a release. "Today, Medicaid serves one in five Americans -- not only the poor, but two-thirds of those in nursing homes, more than 30 million children, and countless individuals with disabilities. To end the Medicaid expansion created under the Affordable Care Act is a cruel joke, as is the blatantly partisan attack on women's health by defunding Planned Parenthood and allowing waivers to opt out of essential benefit requirements that cover maternity care."

Tom Flanagin, a spokesman for U.S. Rep. Elise M. Stefanik, R-Willsboro, said in a statement that she is still reviewing the bill but praised some of its provisions, including ACA tax cuts and coverage for those with pre-existing conditions.

"Congresswoman Stefanik is encouraged that the Senate health care bill repeals costly Obamacare taxes while preserving protections for those with pre-existing conditions," Mr. Flanagin said. "Congresswoman Stefanik will continue to discuss the Senate proposal with her colleagues and constituents as the Senate debates this bill."

Like the AHCA, the Senate bill gives states the option of waiving provisions in the health care bill that could cause high premium rates, such as the regulation for guaranteed pre-existing conditions coverage. States must demonstrate why they need the waiver and that they will adequately provide coverage for high-risk individuals through an alternative program or strategy.

Coverage requirements states may be able to opt out of include maternity care, mental health services and emergency services, offering instead an "essential health benefits" plan. Money not spent to subsidize such services would be, in part, used to fund those extensive tax breaks for affluent Americans, who have been taxed more under the ACA to help support Medicaid's expansion.

Even several Republican senators have criticized the bill, saying it doesn't do enough to address the growing opioid crisis.

"It is absolutely incomprehensible that in the middle of this unprecedented opioid epidemic, Senate Republicans drafted a bill that would deny 2.8 million Americans suffering from the disease of addiction," said Anita K. Seefried-Brown, project director for Jefferson County's Alliance for Better Communities.

An estimated 2.8 million Americans suffering from addiction have been covered under the ACA, and 1.3 million are currently receiving addiction and mental health treatment under the Medicaid expansion.

"Cutting Medicaid for these people is equivalent to condemning them to death," Ms. Seefried-Brown said.

In 2016, Jefferson County saw 23 people die by opioid-related overdoses. According to Ms. Seefried-Brown, there have been a confirmed nine more deaths to date, with the toxicology of four more victims pending, numbers which may continue to rise quickly in the coming summer months.

Many people who struggle with addiction also suffer from a coexisting mental health disorder.

Korin A. Scheible, executive director of the Mental Health Association of Jefferson County, works directly with many north country residents who rely on Medicaid for health insurance and treatment.

"New York state, though not perfect, has made so much progress in bringing services to (people with mental illnesses,)" Ms. Scheible said in late May. "The fact is, (cutting Medicaid) would greatly reduce access to care for our entire population. These are people who don't have the means to be in high-risk pools."

In the last seven years, the rate of uninsured adults dropped from 24 percent to 8 percent in Jefferson County, from 20 percent to 9 percent in Lewis County, from 18 percent to 9 percent in St. Lawrence County and from 16 percent to 8 percent in Oswego County.

Ms. Scheible, on the other hand, compared cuts to the total care of patients with mental health problems to tearing out the spokes of a wheel and still expecting a smooth ride.

"On the surface, this plan is saving money for someone, but at the end of the day, it's going to cost much more. If our clients go untreated, costs to food pantries and home assistance go up, justice and criminal system costs go up and it's a huge strain on all social services," Ms. Scheible said. "It's just pushing the costs down the line."

River Hospital's adult and juvenile mental health services would be placed especially at financial risk and may be the first services to go.

"The impacts of this are all negative, there's no positive," Mr. Moore said. "We operate on a tight margin."

Mr. Moore said he is waiting to see to what extent New York state would be able to mitigate the damage.

Local officials in the north country continue to support Republican healthcare reform plans, especially considering the Faso-Collins amendment remains in the House and Senate version of the bill.

Introduced by U.S. Reps. Christopher C. Collins, R-Lancaster, and John J. Faso, R-Kinderhook, that amendment shifts $2.3 billion in Medicaid costs from counties to the state.

"It will be a significant relief to property taxpayers," said Scott A. Gray, Jefferson County Legislature chairman. "I think the state has certainly a broader range of revenue to cover the cost of the program."

The cost shift has become more enticing to local officials in the last few days as well, as state legislators have not yet come to an agreement that would renew county sales tax rate extensions. If state lawmakers hold off approving a final agreement on those extensions until late in the year, counties may be forced to devise budgets that don't account for millions of dollars in sales tax revenues used to offset Medicaid costs.

St. Lawrence County Attorney Stephen D. Button released a memo Friday calling on local governments throughout the state to pass resolutions supporting the Collins-Faso amendment (known as the Property Tax Reduction Act in the House and the Empire State Equity Act in the Senate).

"It is ultimately Albany's responsibility to design and fund its Medicaid system," the memo said. "Adoption of this federal legislation will finally force Albany to be responsible for its program."

Before the Affordable Care Act's expansions, Medicaid coverage was limited mostly to children, very low-income parents, pregnant women and people with a qualifying disability. Individuals with disabilities, who have long relied on the program, may be disproportionately affected by funding cuts.

"We are a talented, capable population making many contributions throughout the north country. We are employed as peer counselors; we provide benefits advisement to help other people with disabilities return to the workforce; we work in libraries; we are lawyers, retailers, gunsmiths and more," Aileen Martin, executive director of Northern Regional Center for Independent Living, said in a public statement.

"It would be a huge detriment for this entire population of people to exit the community because we could not afford health care coverage or our coverage no longer covers the services we need."

"The wonderful part of the American system is that every person has the right to talk to our elected officials, who need to hear from those most affected by these cuts, people who will feel (losing their insurance) firsthand," Ms. Seefried-Brown said. "Even if one thinks, 'this bill won't affect me, I'm firmly ensconced in the middle class,' it only takes one death in the family or one major illness to end up in poverty."

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