Groups representing pediatricians, cancer specialists, heart doctors and family physicians all agree: Both the House and the Senate offerings for fixing health care in the U.S. would make things worse, not better.
Within hours of its release, groups representing medical professionals were denouncing the Senate version, called the Better Care Reconciliation Act or BCRA.
"The Senate draft health care bill is literally heartless," American Heart Association CEO Nancy Brown said.
"Medicine has long operated under the precept of Primum non nocere, or 'first, do no harm'," The American Medical Association said in a letter to Senate leaders released Monday.
"The draft legislation violates that standard on many levels."
Here are five reasons so many medical professionals oppose the Republican-proposed changes made so far to the 2010 Affordable Care Act:
Medicaid covers half the births in the U.S. right now and the House and Senate bills would both not only pull back the expansion of Medicaid that underlay Obamacare, but reduce federal funding for the original program, too.
“Medicaid coverage for up to 6.5 million women of childbearing age will be rescinded, making it harder for them to get healthy before they get pregnant,” March of Dimes president Stacey Stewart said.
“BCRA discriminates against providers of women’s health services," said Dr. Jack Ende, president of the American College of Physicians.
The bill cuts funding to women’s health clinics that provide "contraception, preventive health screenings, sexually transmitted infection testing and treatment, vaccines, counseling, rehabilitation, and referrals," Ende said.
Medicaid covers 75 million people, including nearly 36 million children, according to data released Friday by the Center for Medicare and Medicaid Services..
“Senate leaders present their bill as providing states with flexibility. The reality is that it will put considerable pressure on states to limit their spending on health care, including for children," said Dr. Matthew Davis, a professor of pediatrics and of medicine at Northwestern University Feinberg School of Medicine.
“The bill includes misleading ‘protections’ for children by proposing to exempt them from certain Medicaid cuts,” added Dr. Fernando Stein, president of the American Academy of Pediatrics.
"A ‘carve-out’ for children with ‘medically complex’ health issues does little to protect their coverage when the base program providing the coverage is stripped of its funding. Doing so forces states to chip away coverage in other ways, by not covering children living in poverty who do not have complex health conditions, or by scaling back the benefits that children and their families depend on,” Stein added.
“Medicaid allows a college student with cerebral palsy to live independently. Medicaid pays for a toddler’s wheelchair, and as she grows over time, it covers the next one and the one after that.”
Medicaid is traditionally the state-federal health plan for the low-income, disabled, and children and cutting it will have repercussions across the health care system as people either wait until they’re at death’s door to get treatment, or head to emergency rooms that by law must save their lives, health policy experts stress. The costs get passed on to taxpayers and people with health insurance.
“Medicaid is there for families struggling from the opioid epidemic, covering treatment for parents and services for their children. Medicaid covers a grandmother’s chemotherapy and a newborn baby’s emergency heart surgery and a six-year-old’s hearing screening and a teenager’s asthma inhaler,” Stein said.
"The Senate proposal would likely trigger deep cuts to the Medicaid program that covers millions of Americans with chronic conditions such as cancer, along with the elderly and individuals with disabilities who need long-term services and support. Medicaid cuts of this magnitude are unsustainable and will increase costs to individuals with private insurance," added Rick Pollack, president and CEO of the American Hospital Association.
But Republican Senator Bill Cassidy of Louisiana says the bills may end up helping people get medical care more easily. "When folks who are on Medicaid – typically there’s only some doctors that see Medicaid patients," Cassidy said on MSNBC's Morning Joe program.
"When they're on private insurance, there’s far – there’s a far broader panel of folks to see. And so if, as we move people to private insurance, they have greater access to doctors, to specialists. That could be a positive thing."
The sick and disabled
“Americans with pre-existing conditions will likewise suffer under this proposal because it would give states the ability to discriminate against the sick by obtaining waivers for essential benefits," said the Heart Association’s Brown.
“States can then create their own essential benefits packages which could exclude prevention benefits, rehabilitation and rehabilitation services — all critical for people with cardiovascular disease.”
States may feel pressured to let health insurers cut back on what conditions they will cover. That could mean cheaper premiums, and create the illusion of more choice, but health policy experts say it will mean bare-bones policies in many states that cover very little.
“This bill creates a false narrative that says it will help people with pre-existing conditions, but instead it allows states to waive essential health benefits such as vital prescription drugs, mental and behavioral health services, and preventive services,” said Paul Kawata, executive director of the HIV advocacy group NMAC.
Medicaid also covers two-thirds of people in nursing homes. The health care bills in the House and Senate would also let companies charge older people more for insurance than they would younger customers.
“We are disappointed that the legislation fails to meet our guiding principles for healthcare reform by halting Medicaid expansion, reinstating annual and lifetime coverage caps, and cutting coverage for essential health benefits including cancer screening,” said Dr. Bruce Johnson, president of the American Society for Clinical Oncology.
“We are concerned that no public hearings were held and no physician or patient expertise was sought during the bill's development,” the American Academy of Family Physicians, American Academy of Pediatrics, American College of Physicians, American Congress of Obstetricians and Gynecologists, American Osteopathic Association and American Psychiatric Association said in a joint statement.
“The American Health Care Act, as passed by the U.S. House of Representatives in May, is an inherently flawed bill that would do great harm to our patients. The Senate's Better Care Reconciliation Act would also leave patients drastically worse off than current law," the statement said.