Understand how we got here — and how to move forward.


July 17, 2017

Opposition mounts to GOP health bill as major insurers, Republican governors weigh in

Daily Briefing

Several Republican governors during a National Governors Association (NGA) meeting on Friday said they oppose the latest version of the Senate GOP's health reform bill.

Updated side-by-side: The ACA vs. the BCRA

GOP moderates and conservatives both criticize the bill—for different reasons

Republican governors were split in their reasons for opposing the Better Care Reconciliation Act (BCRA). More moderate governors expressed concerns about how it could cut Medicaid funding—while conservative governors said the bill does not go far enough to repeal the Affordable Care Act (ACA).

For instance, Nevada Gov. Brian Sandoval (R), a moderate, said he worried about how the bill could affect the 210,000 Nevada residents who gained coverage through the state's Medicaid expansion under the ACA. "I have to be comfortable that those 210,000 lives are going to continue to enjoy the quality of life and health care that they have right now," he said.

Vermont Gov. Phil Scott (R) expressed similar concerns, saying, "Even a small tweak" to the ACA's Medicaid expansion "could have a devastating impact" on his state. He added, "We've made great strides at protecting the most vulnerable and I believe, in its present form, this would not be good for Vermont."

Ohio Gov. John Kasich (R), who did not attend the meeting but has been a vocal critic of the Senate's health reform bill, in a statement issued Friday said the latest version still is "unacceptable" because "its cuts to Medicaid are too deep and at the same time it fails to give states the ability to innovate in order to cope with those reductions."

On the other hand, conservative Kentucky Gov. Matt Bevin (R) criticized the updated version of BCRA because it would keep some of the ACA's taxes intact.

Trump admin looks to gain support from GOP governors

The Trump administration has launched a concerted effort to convince more Republican governors to support the legislation.

According to the Times, Vice President Pence, HHS Secretary Tom Price, and CMS Administrator Seema Verma all attended the NGA meeting on Friday. Pence during the meeting acknowledged governors' concerns with the measure but said the ACA has problems that need to be addressed.

Pence added that BCRA's Medicaid reforms are intended to "ensur[e] for the long run that Medicaid will be there for the neediest," saying too many "able-bodied adults" currently rely on the program. "I really believe, as the president does, that we're saving Medicaid," he said.

The officials also tried to discredit the Congressional Budget Office's prediction that 22 million U.S. residents would lose health coverage by 2026 under BCRA. According to Politico, Verma said tax credits to help people purchase private coverage under BCRA and billions of dollars in funding included in the measure to help stabilize the insurance markets would help to offset coverage losses and give states greater flexibility.

Some governors skeptical about increased flexibility under BCRA

Some governors agreed that BCRA would increase states' flexibility with their insurance programs, but disagreed over what that flexibility could mean for their states.

North Dakota Gov. Doug Burgum, a Republican, said, "I think one of the takeaways is that the way this problem is going to get solved is the governors innovating at the state level," adding, "Any time that you move towards more state flexibility in a market that's this dynamic, then that's a step in the right direction."

However, Louisiana Gov. John Bel Edwards, a Democrat, said while he "acknowledge[s] there's additional flexibilities to the states, … at the end of the day it's going to be the flexibility to cut people." He continued, "You're either going to have fewer people covered, or the coverage you offer will be much less than is currently offered. I'm not interested in that."

Insurers say amendment allowing sale of non-ACA-compliant plans is 'unworkable in any form'

In related news, American's Health Insurance Plans and the Blue Cross Blue Shield Association in a letter sent Friday to Senate leaders wrote that they oppose a provision added to the latest version of BCRA that would allow insurers that meet certain requirements to sell exchange plans that do not comply with the ACA's coverage standards.

In the letter, which was sent to Senate Majority Leader Mitch McConnell (R-Ky.) and Senate Minority Leader Chuck Schumer (D-N.Y.), the groups wrote that under the provision, health plans not compliant with the ACA could "'cherry pick' only healthy people from the existing market making coverage unaffordable for the millions of people who need or want comprehensive coverage, including, for example, coverage for prescription drugs and mental health services."

As such, they wrote, the provision "is simply unworkable in any form and would undermine protections for those with pre-existing medical conditions, increase premiums, and lead to widespread terminations of coverage for people currently enrolled in the individual market" (Greenwood, The Hill, 7/15; Martin/Burns, New York Times, 7/14; AP/Los Angeles Times, 7/15; Sullivan et al., "PowerPost," Washington Post, 7/14; Pradhan, Politico, 7/15; Beech, Reuters, 7/14; Sullivan, The Hill, 7/14; Wilde Mathews, Wall Street Journal, 7/14).

No matter what happens in the Senate: Get the clinical leader's resource guide

No matter the outcome of the debate over the future of the Affordable Care Act and Medicaid, the likely renewed focus on delivery system costs will make further clinical efficiency an imperative.

To help you and your clinical teams operate in this uncertain time, we've created The Clinical Leader's Resource Guide. Inside you'll find the information and no-regrets strategies needed to support clinical outcomes and financial success in any regulatory environment.

Download Now

Have a Question?


Ask our experts a question on any topic in health care by visiting our member portal, AskAdvisory.