Mayors Double Down on Efforts to Block Senate Health Bill

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By Victoria Pelham

Mayors on both sides of the aisle are doubling down on efforts to pressure GOP senators to reject their Obamacare repeal-and replace bill .

The local leaders, unlike governors who have asked for more time to carefully weigh the Senate Better Care Reconciliation Act’s impact, blast the bill’s cuts to Medicaid at a time when their communities are facing a dramatic opioid overdose crisis and need more care, not less. And they warn the plan would shift costs, harm the bottom line for city hospitals, and slash access.

“What’s happening now these last days in Washington really did evolve from growing anger at the grassroots, and it did not have a partisan shape,” New York City Mayor Bill de Blasio (D) said on a U.S. Conference of Mayors press call. But he warned the Senate proposal is not dead.

“The trajectory is different [from the House-passed American Health Care Act], but the ball game is far from over,” he said.

Not an Option

“I’m struck that the federal government in this situation is trying to run away from a burning building,” Mayor John Giles (R) of Mesa, Ariz., said. “That is not what cities do. That is not an option for the mayors of this country.”

While Washington has been engaged in partisan politics, the mayors said, there has been a disconnect with those on the front lines.

They have witnessed police responding to opioid overdose deaths, seen the need for mental-health services, and engaged with local hospitals—often primary employers in many towns and already on the verge of closing with thin margins.

They have seen how Medicaid expansion has insured their vulnerable.

And without these protections, hospitals and lower levels of government will be left to bear the brunt of the cost and to pick up the pieces. That could lead to hospital closures and exacerbate problems in rural areas with already limited access and provider shortages, the city leaders cautioned.

Giles, a Republican, noted the $350 billion in savings sounded attractive, and said he believes there needs to be improvement to the ACA, as well as efforts toward fiscal sustainability and responsibility.

But a focus on emergency care over primary care is costly and less productive, Giles said. Health-care costs would jump up, not down. That buck would be passed downward to shoulder the responsibility.

And 22 million more people left uninsured, as the Congressional Budget Office has estimated would happen under the Senate bill, would create a crisis, Giles said.

Cities and public safety providers are the “bottom-tier” safety net for the needy, the mayors said.

“Quite frankly mayors are sort of left holding the bag,” Reno, Nev., Mayor Hillary Schieve (D) said. “It’s really up to us to come together to have this strong voice.”

CBO Score

A CBO analysis of the Senate bill’s longer-term impact, released June 29, estimates federal spending on the Medicaid safety net would drop by about 35 percent by 2036 under the Senate plan.

That plan would end the federal match for every eligible Medicaid beneficiary, instead putting state programs on a budget with a choice of either a per-enrollee or lump-sum spending cap. It would also wind down funding for the Medicaid expansion over three years that under the Affordable Care Act covered at least 11 million new Americans.

Stripping the safety-net health insurance program would leave many Medicaid enrollees who are dependent on painkillers with no other resources to turn to, the mayors warned. And that would directly lead to more overdose deaths in a crisis like this of natural disaster proportions.

“Choosing not to be a full participating partner in fighting the opiate epidemic is nothing short of political malpractice,” Huntington, W. Va., Mayor Stephen Williams (D) said.

Those in favor of the repeal-and-replace effort have lamented skyrocketing premiums and deductibles that make coverage prohibitively expensive, as well as the dwindling number of insurers in exchanges, lack of competition, and destabilized market.

But in addition to the ACA overhaul, the Republicans are also pitching long-desired entitlement reform that they say will make health care on the whole more sustainable.

Medicaid, a $550 billion-and-growing program, should be reprioritized to protect the truly needy and preserve its long-term future, they say.

Driving the Conversation

The mayors, weighing in from Anchorage, Alaska, to Dayton, Ohio, struck an even deeper tone of opposition to the bill than governors.

The National Governors Association has requested more time to review the bill, though the group has called for bipartisan recommendations and efforts to come together for joint, workable solutions to improve access and lower cost. Individually and in separate letters, several governors from both parties have warned of the need to protect the vulnerable in any Obamacare repeal efforts.

Local leaders are having some success, at least in influencing priorities, John Feore, a director with consultant Avalere Health, said. Republican lawmakers may be more amenable to requests and concerns from those within their own political party than Democrats or neutral trade associations.

Efforts to add billions in opioid funding into the bill, which is being debated, could be a reflection of the lawmakers’ response to mayors who see the epidemic in their own communities.

“They’re making their point; clearly they’re having some influence on the process since the bill has been pulled back,” Feore said.

And other improvements that could show up in the legislation, like a more slow end to the Medicaid expansion, are already on mayors’ and governors’ minds.

“I find it interesting we’re able to work so successfully in a bipartisan manner locally with our national reps but once it gets to wash, then it breaks down,” Williams said.” Locally we don’t have the luxury to avoid issues. We’re expected to resolve the problem, not necessarily set blame as an excuse for inaction.”

The mayors said they’re leaning heavily on their governors and senators, such as Sen. Dean Heller (R-Nev.), who in the past voted for an Obamacare repeal plan that was vetoed by then-President Barack Obama but has opposed the Senate GOP bill.

“This is not the end,” USCM CEO and Executive Director Tom Cochran said on the call. “This is the beginning.”

To contact the reporter on this story: Victoria Pelham in Washington at vpelham@bna.com

To contact the editor responsible for this story: Brian Broderick at bbroderick@bna.com

For More Information

The CBO estimate of the Senate bill's longer-term impact is at https://www.cbo.gov/publication/52859.

Copyright © 2017 The Bureau of National Affairs, Inc. All Rights Reserved.

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