As U.S. Senate Republicans were unveiling their Affordable Care Act replacement plan Thursday, Lawrence resident Mike Oxford was lying on the floor of Senate Majority Leader Mitch McConnell’s office.
Oxford has limited mobility because of a lower-back injury and neurological impairments and is the executive director of the Topeka Independent Living Center.
He was among dozens of people with disabilities who were arrested Thursday at the U.S. Capitol for staging a “die-in” to protest Medicaid cuts in both the Senate bill and the one Republicans in the U.S. House of Representatives passed last month.
“We feel like it’s a direct assault on life, liberty and the pursuit of happiness,” Oxford said in a phone interview from a Washington law enforcement office while waiting to be processed. “It was civil disobedience.”
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The Senate bill, which McConnell has said he wants to vote on next week, is much like the American Health Care Act that Republicans in the U.S. House passed last month.
It wipes out the Affordable Care Act’s individual and employer mandates, expands health savings accounts and changes the tax credits that help low-income Americans buy insurance on the individual insurance market.
U.S. Sen. Pat Roberts, a Kansas Republican, said the bill is a much needed course correction that keeps some popular provisions of the Affordable Care Act, often called Obamacare, while holding down rising premiums and stabilizing markets that are hemorrhaging insurers.
“People with pre-existing conditions will keep their health care,” Roberts said. “Children under 26 remain on the parents’ plans. There are no annual or lifetime limits on coverage. We reduce the deficit; we reform Medicaid, one of the big three entitlements.”
Kansas’ other Republican senator, Jerry Moran, was less enthusiastic and said he hadn’t decided how he would vote.
“If this bill isn’t good for Kansas, it isn’t good for me,” said Moran, who has said he wanted the Senate to start fresh on health care and hold open hearings.
Kansas City-area disability advocates said Thursday that the proposed changes to Medicaid, which begin in 2021, will cut funding more than the 25 percent estimated in the House bill, leading to reduced medical coverage, nursing home care and in-home support services.
Rocky Nichols, executive director of the Kansas Disability Rights Center, said the cuts would affect people who had Medicaid long before the Affordable Care Act expanded it, even in states like Missouri and Kansas that didn’t participate in the expansion.
“This goes far beyond Obamacare expansion repeal,” Nichols said.
Both the House and Senate bills would, for the first time, impose limits on the amount of federal Medicaid dollars going to states. States would be allowed to choose per capita caps based on the number of people in their Medicaid programs or block grants with fewer federal rules.
Nichols said the Senate bill restricts the annual growth rate in those caps more than the House’s.
Jawanda Mast, a disability advocate from Olathe whose daughter has Down syndrome, said that fit with what she had heard from organizations in Washington.
“The cuts are deeper, and it’s worse for people with disabilities,” Mast said. “And we’re still lost. We still get no mention.”
Mast said public attention has been more focused on what the bill would mean for people with pre-existing medical conditions in the individual insurance market.
On that, the Senate has gone in a different direction from the House, by keeping the Affordable Care Act rules that prevent insurers from charging higher premiums based on health conditions.
That could be difficult for insurers to absorb, given that the Senate and House bills also eliminate the Obamacare tax penalty for individuals who don’t carry insurance.
Rob Broomfield, the CEO of UnitedHealthcare’s individual and employer-based insurance business in Kansas, Nebraska and Iowa, said even with that penalty — $695 or 2.5 percent of annual income, whichever is higher — the Affordable Care Act individual market health insurance exchanges aren’t drawing enough healthy people to balance out the chronically ill people who insurers were forced to cover.
That’s why insurers like UnitedHealthcare got out of the exchanges, leaving consumers in Kansas and Missouri with few choices.
“I would say the key thing that the exchanges need to address is you can’t just provide coverage for the people who need it,” Broomfield said Wednesday before the Senate bill was unveiled. “You have to have everybody paying into the pool, otherwise it’s just not sustainable. And the mandates for coverage I don’t think necessarily addressed that to the extent they needed to.”
For people on Medicare and employer-based insurance, the changes in the Senate bill would be minimal.
The Medicaid cuts could affect “dual eligibles” who use Medicaid to fill in gaps in their Medicare coverage. With the end of the employer mandate, businesses with 50 or more employees would be free to not offer health insurance to full-time workers, and the bill also further delays a “Cadillac Tax” on high-dollar employer health plans from 2020 to 2026.