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New U.S. health care bill withdrawn after if falls short of votes in the House of Representatives

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Catholic News Service

WASHINGTON — Sister Carol Keehan, a Daughter of Charity, who is president and CEO of the Catholic Health Association, doesn’t mince words when it comes to the American Health Care Act, which was short of votes and withdrawn by House Republicans late March 24.

U.S. House Speaker Paul Ryan recommended March 24 that President Trump withdraw the American Health Care Act when it didn't have enough votes in the House. (CNS/Joshua Roberts, Reuters)

U.S. House Speaker Paul Ryan recommended March 24 that President Trump withdraw the American Health Care Act when it didn’t have enough votes in the House. (CNS/Joshua Roberts, Reuters)

Two days before the GOP legislation was set for an initial vote in Congress and then delayed due to last-minute wrangling and efforts to gain support, she described the bill as a disgrace, a pro-life disaster, a huge step back, catastrophic for Catholic social teaching and something that would do incredible damage.

The woman religious, who heads an organization of more than 600 hospitals and 1,400 long-term care and other health facilities in the United States, has a vested interest in the nation’s health care and she also knows the ins and outs of health care legislation from working behind the scenes “forever,” as she describes it, on the Affordable Care Act.

At the time that the ACA was being drafted, some Catholic organizations opposed key elements of the measure. Once it became law, more than 40 lawsuits were filed to challenge the subsequent Department of Health and Human Service’s mandate requiring that insurance plans include coverage for artificial birth control, sterilization and drugs that lead to abortions.

Sister Keehan is quick to point out that the health care legislation signed into law seven years ago is far from perfect, but she says it was an “incredible step forward.”

“I do recognize the political conflict and the imperfections in the bill, but when you can make insurance that much better for people who have it and give 20 million Americans insurance, that is a huge step forward,” she said March 21 in her Washington office.

At a 2015 Catholic Health Association gathering in Washington, President Barack Obama thanked Sister Keehan for her steadiness, strength and “steadfast voice.”

“We would not have gotten the Affordable Care Act done had it not been for her,” he said.

The immediate repeal and replacement of the ACA was a key promise of President Donald Trump’s campaign, but the GOP health care measure has faced opposition from both conservative and moderate Republicans. Trump told House Republicans that he will leave ACA in place and move on to tax reform if they do not support the new health care legislation.

Watching the GOP efforts to repeal and replace the ACA has been hard for Sister Keehan mainly because she and other health care leaders were not consulted in the process.

“We should never, ever throw together a bill that’s going to be such a profound impact on the people of this country in this short of time and without any input from those who care for them,” she said.

The work on these two health care bills couldn’t have been more different, she pointed out, noting that prior to the ACA launch she felt like she “lived in committee rooms” because she was constantly meeting with committees, groups and subgroups at the White House and Congress.

With the GOP health care plan, she said there wasn’t any opportunity for hospital groups or the American Medical Association to give any advice.

“We’ve just been dismissed,” she said, noting that she attended a few small group meetings on Capitol Hill but “they were not meetings to get our input on what ought to be done with the bill but meetings to tell us what was going to be done.”

“This has just been railroaded through Congress,” she added.

While the U.S. bishops have applauded pro-life elements of the American Health Care Act, they also have criticized other elements and expressed concern for its impact on the disadvantaged.

In a March 17 letter to House members about the GOP measure, Bishop Frank J. Dewane of Venice, Florida, chairman of the bishops’ Committee on Domestic Justice and Human Development, said the inclusion of “critical life protections” in the House health care bill is laudable, but other provisions, including those related to Medicaid and tax credits are “troubling” and “must be addressed.”

He said the bill’s restriction of funds to providers that promote abortion and prohibiting federal funding for abortion or the purchase of plans that provide abortion “honors a key moral requirement for our nation’s health care policy.” But he also criticized the absence of “any changes” from the current law regarding conscience protections against mandates to provide certain coverage or services considered morally objectionable by employers and health care providers.

“The ACA is, by no means, a perfect law,” Bishop Dewane said. “The Catholic bishops of the United States registered serious objections at the time of its passage. However, in attempting to improve the deficiencies of the ACA, health care policy ought not create other unacceptable problems, particularly for those who struggle on the margins of our society.”

Main provisions of the new House bill include: eliminating the mandate that most individuals have health insurance and putting in its place a new system of tax credits; expanding Health Savings Accounts; repealing Medicaid expansion and transitioning to a “per capita allotment”; and prohibiting health insurers from denying coverage or charging more money to patients based on pre-existing conditions.

Sister Keehan said she thanked Bishop Dewane for his letter to Congress and said the bishops had carefully gone through the legislation measure by measure on a number of issues. She also noted that she knows people in the pro-life community either think the new bill is strong enough or not doing enough.

As she sees it, the bill is “a pro-life disaster in the fact that when you take health care away from people, you take life.”

“If you want to really, really strengthen the pro-life culture in this country, you make sure people know that their lives and the lives of their children are so valued by our country,” she said, which means providing quality maternity and pediatric care and offering programs like Head Start and food stamps.

Although she said under the ACA no federal funds could be spent on abortion, a nonpartisan government agency in an assessment of the law in 2014 said abortion coverage was available in some plans. Sister Keehan also said the law included help for pregnant mothers to get drug rehabilitation, housing and maternity care, which are not included in the new bill.

“I don’t find this a pro-life bill at all from every perspective,” she added about the new measure.

When asked if there was a silver lining with people at least talking about the need to provide insurance for all Americans, Sister Keehan said the health care crisis for so many people doesn’t give “the luxury of time.”

“To be the only industrialized nation in the world that does not guarantee all its citizens health care is a disgrace,” she said, adding: “We are at a real crossroads in our country’s sense of its responsibility to its people.”

 

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House’s health care bill has both laudable and troubling aspects, bishop says

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WASHINGTON — The inclusion of “critical life protections” in the House health care bill is laudable, but other provisions, including those related to Medicaid and tax credits, are “troubling” and “must be addressed” before the measure is passed, said the chairman of the U.S. bishops’ domestic policy committee.

Bishop Frank J. Dewane of Venice, Florida, who is chairman of the bishops’ Committee on Domestic Justice and Human Development, sent a letter March 17 to House members. It was released March 20 by the U.S. Conference of Catholic Bishops.

Congressman Jim Renacci, R-Ohio, takes notes as he listens to House Budget Committee lawmakers deliver statements on the American Health Care Act during a March 16 hearing on Capitol Hill in Washington. (CNS photo/Shawn Thew, EPA)

Congressman Jim Renacci, R-Ohio, takes notes as he listens to House Budget Committee lawmakers deliver statements on the American Health Care Act during a March 16 hearing on Capitol Hill in Washington. (CNS photo/Shawn Thew, EPA)

Regarding life protections in the bill, Bishop Dewane said: “By restricting funding which flows to providers that promote abortion and prohibiting federal funding for abortion or the purchase of plans that provide abortion, including with current and future tax credits, the legislation honors a key moral requirement for our nation’s health care policy.”

Among the “very troubling features” of the bill are the Medicaid-related provisions, he said. Other aspects that must be addressed before the bill is passed include the absence of “any changes” from the current law regarding conscience protections against mandates to provide certain coverage or services, Bishop Dewane said.

His letter follows one sent March 8 to House members by him and three other bishops’ committee chairmen stating they would be reviewing closely the American Health Care Act, introduced in the House March 6 to repeal and replace the Affordable Care Act.

The other signers of the earlier letter were: Cardinal Timothy M. Dolan of New York, chairman, Committee on Pro-Life Activities, Archbishop William E. Lori of Baltimore, chairman, Ad Hoc Committee for Religious Liberty; and Bishop Joe S. Vasquez of Austin, Texas, chairman, Committee on Migration.

In his March 17 letter, Bishop Dewane said one area in the new bill that could be helpful, with “appropriate safeguards,” is an effort to increase flexibility for states and provide more options for health care savings and different kinds of coverage based on economic levels. But still, Bishop Dewane said, “efforts to increase flexibility must be carefully undertaken so as not to undermine” a given program’s “effectiveness or reach.”

In the House bill, Medicaid expansion would be repealed and replaced with a “per capita allotment.” Under the current law, more Americans became eligible for Medicaid, so long as their states opted into the entitlement program’s expansion.

The House bill’s “proposed modifications to the Medicaid program, a vital component of the social safety net, will have sweeping impacts, increasing economic and community costs while moving away from affordable access for all,” Bishop Dewane said.

He also cited the nonpartisan Congressional Budget Office’s assessment of the bill that said “as many as 24 million additional people could be uninsured in the next 10 years for a variety of reasons.”

The U.S. bishops, he said, have stressed that “all people and every family must be able to see clearly how they will fit within and access the health care system in a way that truly meets their needs.”

The CBO estimates millions of people currently eligible for Medicaid under the law “will be negatively impacted due to reduced funding from the per capita cap” proposal, Bishop Dewane said.

“State and local resources are unlikely to be sufficient to cover the gaps,” he continued.

Congress needs “to rework the Medicaid-related provisions of the AHCA to fix these problems and ensure access for all, and especially for those most in need,” said Bishop Dewane.

He also pointed out that the House measure does not provide “conscience protection against mandates to provide coverage or services, such as the regulatory interpretation of ‘preventive services’ requiring contraception and sterilization coverage in almost all private health plans nationwide.”

The mandate requiring most employers to provide such coverage even if they are morally opposed to it, he reminded House members, “has been the subject of large-scale litigation especially involving religious entities like the Little Sisters of the Poor.”

Bishop Dewane outlined other provisions he said need to be addressed before the legislation is passed, including:

  • The new tax credit system, which “appears to create increased barriers to affordability, particularly for older and lower-income people when compared with the cost assistance” allowed under the current health care law.
  • The cap on the cost of plans for older Americans relative to plans for younger people would increase to a 5-to-1 ratio over the current 3-to-1 ratio. Studies show, Bishop Dewane said, that “premiums for older people on fixed incomes would rise, at times dramatically” under the House proposal.
  • A 30 percent surcharge for a 12-month period for those who do not maintain continuous coverage “presents a serious challenge.”
  • No longer any requirement for states to allow individuals seeking Medicaid benefits a reasonable opportunity to verify that they are either U.S. citizens or have a qualified immigration status. “This change would undoubtedly threaten eligible individuals’ access to essential and early medical care,” the bishop said.

The current federal health care law “is, by no means, a perfect law,” Bishop Dewane said, noting the U.S. bishops “registered serious objections at the time of its passage” in 2010.

“However, in attempting to improve the deficiencies of the ACA, health care policy ought not create other unacceptable problems, particularly for those who struggle on the margins of our society,” he said.

The U.S. bishops “look forward to working with Congress to address the problems found in the AHCA, to ensure that all people can benefit from comprehensive, quality health care that they can truly afford.”

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