Patient advocates still opposed, senators still support new health-care bill

July 16--CHEYENNE -- The U.S. Senate health-care bill might have changed since the debacle before the July 4 recess, but the positions of its proponents and opponents in Wyoming remain largely the same.

Sen. Mitch McConnell, R-Ky., wanted a vote on the Better Care Reconciliation Act -- the Senate's bill meant to repeal and replace the Patient Protection and Affordable Care Act, also known as Obamacare -- before the July 4 recess.

But McConnell abruptly called off the vote when it was clear he was well short of the Republican votes he needed.

On Thursday, McConnell revealed a revised bill meant to bring moderate and conservative Republicans into the fold. While there are changes, the fundamentals of the bill remain essentially the same.

Some of the highlights include:

* The bill still repeals most of the Obamacare taxes, but now leaves some taxes on the wealthiest Americans in place.

* More money was added to address the nationwide opioid crisis.

* Additional funds are added to help states lower costs for individuals buying their own coverage.

* Health savings accounts can now be used to pay insurance premiums.

In McConnell's best attempt to strike a delicate balance, he has already lost two of the critical GOP votes. Conservative-leaning Sen. Rand Paul of Kentucky and moderate Sen. Susan Collins of Maine told reporters they will not be voting to even introduce the bill for debate. If one more Republican decides to side with the no's, it's over for now.

Wyoming Sens. Mike Enzi and John Barrasso, both Republicans, were part of the 13-senator working group that developed the bill. Enzi released a statement Thursday, claiming the revisions offer increased options and help for Americans in need. Before the initial vote was canceled, Enzi said he was willing to give it more time to work out a bill palatable to his Republican colleagues. That, he said, is what they've done.

"We shared a draft a few weeks ago for everyone to see. We've listened and made revisions. All senators will have a chance to offer further changes in an open amendment process. This is how legislating works," Enzi said.

Barrasso released a statement Friday that reiterated many of his long-held talking points and echoed some of Enzi's statements.

With rising premiums across Wyoming, Barrasso said the GOP reforms to health care would stabilize insurance markets and lower premiums.

"It repeals many of the mandates and taxes that drove up costs under Obamacare," Barrasso stated. "We also provide subsidies to those who need them."

Both Enzi and Barrasso highlighted the revision that could help rural hospitals by allowing for more accurate disproportionate share hospital payments, commonly called DSH.

"It's also important to point out that under this bill, Wyoming will be getting more money in terms of disproportionate share hospital payments," Barrasso stated. "This will help cover the costs of caring for patients in our state."

Eric Boley, president of the Wyoming Hospital Association, said the organization is still concerned about how the bill would affect Medicaid funding and the insurance market in coming years. While he said the DSH provision would be good for Wyoming, it's not enough to win his support.

"We're still analyzing it, but my initial reaction is there's a little bit of good news, but we still have some major concerns," Boley said. "They did put additional funding in there (for DSH payments) that would give some additional help to the state of Wyoming, but it's still nowhere near what the reduction in payments over time are going to mean for the Medicaid program. It's better than it was a week ago, but we still have major concerns."

Phyllis Sherard, vice president of population health and chief strategy officer at Cheyenne Regional Medical Center, said she still is not satisfied, despite the senators being open to the hospital's feedback. She said concerns about patient protections, coverage levels, minimum benefits, Medicaid, Medicare and other critical points have not yet been addressed.

As such, Sherard said the Cheyenne hospital remains opposed to the legislation.

"Ultimately, the revised bill does not offer stability for hospitals and providers," she said. "It would still significantly cut federal spending on health care, increase the uninsured rate and decrease the actuarial value of coverage among those with insurance -- in some instances, perhaps even more dramatically than previous iterations of the bill.

"If these changes go into effect, Wyoming's state Medicaid program will likely have to modify some combination of Medicaid eligibility, benefits and payments rates -- all of which will negatively impact hospitals and providers and the most vulnerable populations to which we provide care."

AARP Wyoming State Director Sam Shumway said it's a good thing that a provision in the revised bill retains a payroll tax that would extend the solvency of Medicare. However, that's not enough to shift his opposition, either, he said.

"We're glad for that, but -- and this is a huge 'but' -- all the other bad stuff is still here," he said. "There's still an age tax, which means insurance companies can charge older people five times what they're charging younger people for the same coverage. It still guts Medicaid. It still includes or removes protections for people with pre-existing conditions."

Wyoming is among states that have only one insurer, with relatively high insurance costs and deductibles.

"When I speak with folks in Wyoming, I am constantly told that Obamacare does not work for their families -- they want choices," Barrasso said.

Shumway said he agrees changes need to be made to the health-care law, but the GOP's plan as it stands is dangerous for the people he advocates for.

"There are improvements that can be made to (the Affordable Care Act) -- we've been saying that from the beginning, ways to make it more efficient, to keep premiums lower -- but this isn't the answer," he said.

Enzi said he's disappointed with the nature of the opposition to the bill.

"I'm disappointed in the fear-mongering that we're seeing," Enzi said. "Opposition seems automatic, mechanical. That doesn't help us make the changes we need to make. Americans with pre-existing conditions will be able to get coverage. It will strengthen Medicaid for those who need it most. There are no lifetime limits."

As long as Senate Republicans don't lose any more votes, the bill could be introduced for debate next week. If it clears that barrier, the bill would be open to amendments.

The new bill contains a provision proposed by Sen. Ted Cruz, R-Texas, which would let insurers sell plans with minimal coverage as long as they also sell plans that include policies that meet requirements established under the current health-care law. Barrasso expressed support for Cruz's proposal.

"Senator Cruz's amendment gives people the freedom to choose less-expensive options that may be right for them," he said.

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