A wide swath of the American health care system opposes the health care legislation the U.S. House narrowly passed Thursday — and Minnesota's industry is no exception.
Minnesota's eight House members voted along party lines as the House voted to gut the Affordable Care Act, also known as Obamacare. The bill heads now for a fight in the U.S. Senate, where it faces an uncertain future.
The state's health care sectors, however, are raising alarm about the potential for the legislation, known as the American Health Care Act, to become law.
"We are concerned that the American Health Care Act is going to cause a huge retreat in the number of people who are insured," said Wendy Burt, spokesperson for the Minnesota Hospital Association, which represents nearly all the state's health systems and hospitals.
The legislation would scrap the Medicaid expansion and cap federal funding of the insurance program for low income and disabled people. It would also let states do away with consumer protections designed to ensure health insurance coverage is robust and remains available to the half of Americans with a pre-existing health condition.
States could get federal waivers that permit insurers to offer stripped down coverage, and charge more based on age and health conditions.
The quality of health care for many Minnesotans and the financial health of the hospitals and clinics that provide healthcare services are at stake, said Burt.
"We don't want to go back to the system that increases the number of uninsured where people rely on the emergency room," she said, "rather than on preventative care and we increase the amount of charity care and uncompensated care."
Minnesota Republicans who voted for the measure Thursday said the current Affordable Care Act was unsustainable. The three Republicans issued statements slamming Obamacare and saying the legislation they backed will improve the situation.
"The status quo under Obamacare is no longer acceptable," GOP U.S. Rep. Erik Paulsen said in a statement.
States that allow insurers to charge more based on pre-existing conditions would have to set up what are called high risk pools to offer coverage for people with high cost conditions. Although the bill shifts much decision-making to the states, it's unclear whether legislatures or governors are authorized to make those decisions.
"I'm stunned that it's gotten this far given how many negative consequences it has on people all across the country," said Minnesota Human Services Commissioner Emily Piper, who oversees the state's Medicaid program, known as Medical Assistance.
She said the state would lose $2.5 billion in federal Medicaid money within the first 18 months of the bill's implementation, and $35 billion over a decade. That loss would be devastating for more than 1 million Minnesotans enrolled in Medicaid and MinnesotaCare, another state-subsidized health plan, she added.
As for returning to high-risk pools, Piper echoes many experts saying it's not at all clear that the federal subsidies in the bill would do enough to cover the cost. Prior to the Affordable Care Act, high-risk pools were an expensive option of last resort, she added.
"They're looking through rose-color glasses. We had one of the oldest and the biggest high-risk pools in the nation in the state of Minnesota and it had issues including driving up costs, significant costs, that people couldn't afford," Piper said.
The group that represents Minnesota's major health insurance companies opposes the bill. But Minnesota Council of Health Plans President Jim Schowalter underscored that the House GOP plan is a long way from becoming law. He predicts many of the proposals won't survive in the Senate, although Republicans control that body too.
"This is one vote. The law doesn't change over night and for that I'm grateful," Schowalter said. "I think there's a lot of work and a lot of discussion that's going to happen in the U.S. Senate."
Minnesota's two DFL U.S. senators oppose the GOP bill and DFL Gov. Mark Dayton is pledging to fight any effort to reduce health insurance benefits for as long as he's governor. His term ends in January 2019.
Minnesota Medical Association Board Chair, Dr. Douglas Wood, a Mayo Clinic cardiologist, said the state's largest doctors' organization is urging people to get involved in the debate. The MMA, like many other groups, is convinced if the House bill became, law millions of Americans will lose their coverage and their health will suffer as a result, Wood said.
"The general public should quickly contact their senators and express their concern," he added. "We know that the lack of coverage results in delays in care and choices not to do things that are more appropriate that have real impact on their lives. So, as a provider, this is particularly disconcerting."