Health Care Reform: Where Does It Stand?

Jun 30, 2017

Until a few days ago, Senate Republican leaders had been saying they hoped to vote on their version of the bill to repeal the Affordable Care Act before the July 4 holiday.  That plan went by the wayside amid opposition to the secretly drafted legislation from Democrats and some Republicans, as well.

Now, Senate leader Mitch McConnell says he hopes to have a revised piece of legislation ready for a full Senate vote by the August Congressional recess, but it’s unclear where there will be enough changes to sway both moderate and far right-leaning Republicans to vote for the bill.

Barbara Zabawa is a professor of health policy at the University of Wisconsin Milwaukee as well as Lake Effect's regular health care reform contributor. Below are some quotes from Zabawa's conversation with Lake Effect:

Similarities of Senate and House Proposals

"The differences, to me, aren't that great. They're both tackling the coverage issues, affordability of premiums and cutting Medicaid. [Cutting Medicaid] is where most of the savings would come from that will balance out the repeal of all the taxes that both bills want to do away with."

Winners and Losers in the Proposals 

"The winners may be younger, healthier individuals who may pay less for health coverage, but the coverage may not be as robust as it is now. The people who are older and less healthy are going to pay more on average."

Health Care Entities Not On Board

"When the Affordable Care Act was passed in 2010, there was buy in from different industry groups...and it's not the case this time. It's telling that a lot of the health care interest groups, the providers, the American Medical Association and the Hospital Associations, as an example, are all opposed to these bills, some of the insurers are also opposed, even though they would get rid of some of the restrictions imposed on insurers."

Lesser Known Aspects of the Proposed Senate and House Bill

  • Elimination of Public Health Trust Fund

"In both the House and Senate bill is a significant reduction, almost an elimination if I recall, of the public health trust fund. That is billions of dollars that go towards preventing health problems: chronic diseases, providing immunizations... better water, reducing lead exposure, those kind of things that are worked on by public health and community health departments, and others interested in preventing illnesses from happening in the first place, which goes to reducing overall health costs."

Zabawa says of the rationale behind the trust fund was "if we can keep people out of the health care system, we will see fewer expenses being paid out to the health care industry."

  • Lack of Focus on High Cost of Care

"Health costs are just enormous in this country. The bills are just focusing on how much do we as individuals pay for care... but it's not getting at how much is being charged and why those charges are so high." 

  • Senate Bill Provision to Bundle Individual Users into Trade Group

"The Senate bill does have a provision that would facilitate the ability of trade associations to build larger group plans together. That I know will be of interest to a lot of different member organizations."

Effects of Large Numbers of Uninsured

"People will still seek care in emergencies. That care isn't free, somebody has to pay for it. How it usually works is that if a person who seeks the care can't pay for the care, the hospital has to write it off as bad debt or uncompensated care, and then usually they have to raise prices for people who do have coverage."

"It is not good news for [hospitals]. They are going to lose a lot of people who are now using their services and have a means to pay for it."