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American Health Care Act falls short on coverage

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WASHINGTON — The drive to repeal and replace Obama­care has hit a roadblock.

The Congressional Budget Office found that the G.O.P.-led American Health Care Act (AHCA) would leave 23 million more people uninsured in a decade. The CBO assessment cast further doubt on the chances of the Senate passing a similar bill to the AHCA, which was narrowly approved by the House in early May.

“I don’t know how we get to 50 at the moment,” Senate majority leader Mitch McConnell (R., Ky.) told Reuters, referring to the need for a majority to approve legislation.

The AHCA would increase the rolls of the uninsured by 14 million next year, according to the CBO, which said the number would climb to 23 million by 2026, compared to what would happen under President Obama’s 2010 Affordable Care Act. The budget office report, which said the bill would cut the deficit by $119 billion, noted that in many states consumers who are sick or have preexisting conditions would face steep rises in the cost of care. Healthy people would find their premiums dropping, it said.

In states getting waivers for certain health insurance requirements, “premiums would vary significantly according to health status and the types of benefits provided, and less-healthy people would face extremely high premiums,” the budget office said. And “out-of-pocket spending on maternity care and mental health and substance abuse services could increase by thousands of dollars,” it added.

The findings left some GOP senators unfazed. “Regardless of any CBO score, it’s no secret Obamacare is collapsing under its own weight,” said David Perdue (R., Ga.). “Families need real relief now from the limited choices and skyrocketing costs of the failed law. Doing nothing is not an option. The Senate is working now to build on the efforts in the House to make our health care system more affordable and accessible for ­everyone.”

In a statement before the report was released, McConnell called the score “a technical procedural step.” Beyond probably “reiterating things we already know — like that fewer people will buy a product they don’t want when the government stops forcing them to — the updated report will allow the Senate procedurally to move forward in working to draft its own health care ­legislation.”

Senate minority leader Chuck Schumer (D., N.Y.) had a predictably different reaction. “Unless you’re a healthy millionaire, Trumpcare is a nightmare,” he said. “This report ought to be the final nail in the coffin of the Republican effort to sabotage our health care system.”

The score’s negative findings were challenged by the White House, with a spokesman saying “history has proven the CBO to be totally incapable of accurately predicting how health care legislation will impact health insurance coverage.”

But GOP legislators hailed the report’s finding that premiums would fall for healthier people, and that average premiums for some individuals would be cut by up to 30% through 2026.

“This CBO report again confirms that the American Health Care Act achieves our mission: lowering premiums and lowering the deficit,” said House speaker Paul Ryan (R., Wis.). “It is another positive step toward keeping our promise to repeal and replace Obamacare.”

But the assessment left Sen. Dean Heller, (R., Nev.), unchanged in his opposition to the House legislation. The bill “does not do enough to address Nevada’s Medicaid population or protect Nevadans with preexisting conditions,” he said. “The AHCA is a first step, but not the solution.”

Rep. Tom Cole (R., Okla.) said the report, while making headlines and letting Democrats score political points, likely won’t affect policy. “The reality is the Senate’s going to do something very different, and so I’ve never worried that much about it,” he said.

McConnell said that health care is dominating the Senate’s agenda, with a 13-member working group meeting three times a week to come up with a bill that can pass without Democratic support. He wants a measure to be approved by the August recess, but a Senate bill will need a fresh CBO score before it can get a vote.

Sen. Susan Collins (R., Maine) said, “This is an extremely important debate with significant implications for millions of Americans. We need to spend the time necessary to get this right and work to achieve the goal of expanding access to health care that is truly affordable and accessible.”

Neil Trautwein, vice president for health care policy at the National Retail Federation, said the CBO score “clearly shows that there is a lot of work ahead. Nothing in health reform is ever easy. But, we are still encouraged by the prospects for relief from the ACA’s unnecessary compliance burdens. Hopefully, all sides will continue to focus on building a health care system that works best for retail employees and employers.”

In a letter to McConnell and the other members of the working group, National Community Pharmacists Association chief executive officer B. Douglas Hoey urged that a number of important prescription drug-related provisions be retained in any overhaul or replacement of Obamacare.

“Prescription drug coverage is an essential health benefit,” wrote Hoey. “Any meaningful drug coverage should include patient choice of pharmacy and access to face-to-face counseling with a community pharmacist they know and trust.”

The letter asserts that pharmacist-provided prescription drug therapy is “incredibly cost effective” in helping improve medication adherence by patients, which in turn “improves health outcomes and reduces much more expensive interventions, such as emergency room treatment.”


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