Hospitals, doctors, health insurers and some consumer groups, with few exceptions, are speaking with one voice and urging significant changes to the Republican health care legislation that passed the House on Thursday.
In contrast to hospital and doctor groups, insurers had largely remained silent about their reservations, perhaps in the hopes of bartering their low profile in exchange for assurances that billions of dollars in subsidies for low-income coverage would continue. The White House and Congress have gone back and forth about their willingness to pay for the subsidies, prompting anxiety among some companies. Several, including Anthem, have threatened to sharply raise their prices or leave markets altogether without the funding.
The overriding concern — for insurers, many workers and officials throughout the health care systems in many states — is the broad reductions proposed for Medicaid. Even for insurers that have largely abandoned the individual market, like UnitedHealth Group and Aetna, a substantial portion of their business is providing coverage under Medicaid. The same is true for many local nonprofit plans, said Ceci Connolly, the chief executive of the Alliance of Community Health Plans.
Employers and others said they were also concerned about the effects on freelancers, who do not have a traditional employer but are self-employed or contract workers in the so-called gig economy.
Depending on their income, those workers have shuttled between Medicaid and the individual insurance market under the federal health care law, which offered a greater level of stability, said Nell Abernathy, vice president for research and policy at the Roosevelt Institute, a left-leaning economic research organization.
Small businesses, which were sharply divided over the original law, remained mixed in their response to the Republican bill, and there seemed little doubt that some companies would drop coverage in the absence of any penalty. In other people’s view, employees of small businesses would lose out if Medicaid were rolled back or the exchanges became threadbare, because many smaller companies rely on employees’ ability to obtain coverage through the government program or individual market.
The recent amendments to the bill also raised questions about coverage for people with pre-existing medical conditions, which has become an emotional flash point for opposition. The bill would allow states to waive some of the current rules banning insurers from charging sick people more or excluding certain benefits, and those waivers could have broad effects if employers are no longer required to provide comprehensive coverage. Before the Affordable Care Act, many employers capped how much they would pay for care over a person’s lifetime at $2 million, said Tracy Watts, a senior partner at Mercer, a benefits consultant.
While it is unclear what states would allow under a waiver or when such waivers would go into effect, employers could revisit the limits and drop types of benefits if a state deemed them nonessential.