UPDATED 7/28: Reaction to Senate Health Reform Measures

Jul 28, 2017 at 11:43 am by Staff

July 28, 2017 ... Reaction to the failure to pass 'skinny repeal.'

AHA President & CEO Rick Pollack Statement on Skinny Repeal Vote

"From the outset of this process, we have remained consistent in our call for the protection of coverage, the protection of the Medicaid program, and the stabilization of the Health Insurance Marketplace. Our commitment to fighting for those critical objectives remains unchanged.

"The Senate's vote provides not a victory for one side or a loss for the other, but rather a new opportunity to reset and regroup. Working together, both parties in both chambers should utilize this opportunity to fix the very real problems facing our health care system. The result this morning shouldn't mark the conclusion of the debate but should serve as a catalyst to restart it in a bipartisan manner.

"Ultimately, any changes to the Affordable Care Act must ensure the continuity of access and coverage for all who currently have it. We are hopeful that, as this process moves forward, lawmakers will demonstrate their determination to meet these standards that the American people both expect and deserve."

THA President and CEO Craig Becker

"While the 'skinny repeal' did not pass, there now is opportunity for lawmakers and stakeholders to work together to address several key issues that affect Tennessee hospitals and the patients they serve. Chief among these issues is stabilization of the individual insurance market.

"Throughout the past several weeks, THA has offered recommendations that would make healthcare accessible for all Tennesseans and bring much needed stability to hospitals, especially those in rural areas.

"THA looks forward to continuing to work closely with our congressional delegation to take positive action on these and other hospital priorities."

Statement from David O. Barbe, M.D., President, American Medical Association

"While we are relieved that the Senate did not adopt legislation that would have harmed patients and critical safety net programs, the status quo is not acceptable. We urge Congress to initiate a bipartisan effort to address shortcomings in the Affordable Care Act. The first priority should be to stabilize the individual marketplace to achieve the goal of providing access to quality, affordable health coverage for more Americans."
Statement by American College of Emergency Physicians, Becky Parker, MD, FACEP

"We have expressed concerns throughout this process regarding the devastating impact some of the repeal proposals under consideration could have had. Looking ahead, we now urge lawmakers on both sides of the aisle to work together to address the serious problems that still exist involving the health insurance market. These solutions must include appropriate protections for the tens of millions of emergency medical patients that go to emergency departments each year.

"Guaranteed coverage for emergency medical care must continue to be protected by federal law. Patients should be able to seek and receive emergency care when and where it is needed, without fear that their insurance company will not cover it. In addition, when patients have insurance plans with unreasonably high deductibles, they often delay medical care until the problem becomes a life-threatening emergency.

"Policymakers, lawmakers, business leaders, physicians and health care experts must work together to help improve a health care system that benefits every American."

Alexander Statement on Vote
"I voted to take the next step toward what I believed was our best opportunity to repeal and replace Obamacare. The Senate's failure to do this leaves an urgent problem that I am committed to addressing: Tennessee's state insurance commissioner says our individual insurance market is very near collapse. Unless Congress acts, many of the 350,000 Tennesseans who buy health insurance in that market--songwriters, farmers, the self-employed--face the real prospect of having zero options to buy insurance in 2018 and 2019."

Tennessee Justice Center Executive Director Michele Johnson

"We are grateful for last night's miracle. At a moment when lives were literally on the line, we give thanks for the courage of Senator McCain and the other Republican senators whose hearts were moved to vote in the interests of the American people, rather than on the basis of party politics. We are so proud to be with the many thousands of Tennesseans who prayed, phoned, wrote and spoke up for decency and common sense. When it comes to healthcare for our families and neighbors, we have found our voices and won't be silent again. Now it is time for Senators Alexander and Corker to provide leadership in finding bipartisan healthcare solutions that work for all Americans."

July 26, 2017 ... Reaction to the latest movements on the Senate healthcare reform efforts:

Corker to Vote for Amendment to Repeal Core Elements of Obamacare

7/26/17 ... U.S. Senator Bob Corker (R-Tenn.) today announced he will vote for an amendment to repeal the core elements of Obamacare, while allowing for a reasonable transition period for a replacement to be developed and implemented. The amendment vote is currently scheduled for Wednesday afternoon.

"As I have said before, I believe the best path forward is for Congress to repeal Obamacare after a reasonable transition period," said Corker. "This amendment would take us back to a level playing field where, by a date certain, all sides have incentive to work together to develop a health care replacement that would generate broad support and stand the test of time. I urge my colleagues to support this amendment and am eager to continue our work on this issue."

Cooper Statement on Senate Republicans' Healthcare Vote

"The Senate has, until now, been known as the thoughtful, deliberative house of Congress. Republican senators just voted to advance consideration of multiple healthcare plans that have received no hearings, but will reorder one-sixth of our economy and throw millions of people off of their health insurance," Rep. Cooper said. "So today marks a dramatic change in our history. It's shameful. I ask Tennesseans to continue to engage with their representatives and senators. All Americans deserve affordable health care that works and that doesn't bankrupt our country or our families."

AHA President & CEO Rick Pollack Statement on Motion to Proceed

Although we are certainly disappointed by today's development, we are also more determined than ever to help advance solutions aimed at protecting coverage. As the Senate prepares to undergo its amendment process, it is our hope that the critical task of repairing our health care system can be achieved on a bipartisan basis. Put simply: Our challenges are too great and our opportunities too promising to let political partisanship dictate the path forward for America's patients. Those of us on the front lines of health care know all too well the consequences repealing the ACA would have on patients. Ultimately, however, any legislative efforts that entail devastating cuts to the Medicaid program or coverage losses will be opposed with the same vigor that was responsible for the Senate's inability to debate the AHCA until now. Amid all of the uncertainty surrounding the health care reform debate, this fact remains unmistakably clear: We will always fight tirelessly for the patients and communities we serve.

Alexander Statement on Vote to Proceed

"Every senator, Republican and Democrat alike, will now have a virtually unlimited opportunity to debate and offer amendments to help put together a health care bill that helps Americans. Throughout this process, my focus will be on Tennessee, where 350,000 Tennesseans who buy their insurance in the collapsing individual market--songwriters, farmers, the self-employed, small businessmen and women--may find themselves with zero options in 2018 and 2019."

Corker Statement on Vote to Proceed

"Every senator - on both sides of the aisle - will now have the opportunity to offer amendments and have their voice heard on the Senate floor, and I am hopeful that the final product developed by both chambers will be one that works better for the American people than what is in place today," said Corker.

Statement from Michele Johnson, Executive Director of The Tennessee Justice Center

"The Senate leadership's abandonment of its attempt to 'repeal and replace later' is a stunning defeat and a testament to the statewide sacrifice and relentless diligence of Tennesseans over these past few months. With the endless flood of calls, letters to the editor, prayers, and town halls, Tennesseans voiced their opposition to all congressional attacks on healthcare coverage for their neighbors. We celebrate this moment as a great victory for all Tennesseans. This process has brought forward a powerful chorus of voices for a better health care system. We celebrate this strong group of warriors: moms and granddads, nurses, clergy, people with disabilities, doctors, hospitals. Together we will keep pushing for policies that reflect our values. We call on our elected officials to now turn their attention to finding real solutions to the problems impacting real Tennesseans."

Statement from David O. Barbe, M.D., President, American Medical Association

"The health reform debate is by no means over. Congress must begin a collaborative process that produces a bipartisan approach to improve health care in our country.

"The status quo is unacceptable. Near-term action is needed to stabilize the individual/nongroup health insurance marketplace. In the long term, stakeholders and policymakers need to address the unsustainable trends in health care costs while achieving meaningful, affordable coverage for all Americans. The American Medical Association is ready to work on short- and long-term solutions.

"The Medicare Access and CHIP Reauthorization Act and the 21st Century Cures Act are recent examples of what can be accomplished to improve the health of the nation when Congress works on a bipartisan basis with key stakeholder groups. Success is achieved when patients, physicians and policymakers work together to improve the health of individuals, families and communities.

"I want to thank the hundreds of thousands of patients, physicians and other providers for their pivotal participation in the debate on health reform. The grassroots response and their continued involvement moving forward demonstrate the vitality of our democracy."

Statement from Rick Pollack, President and CEO, American Hospital Association

Throughout this debate, we have remained consistent in our call: Protect care for patients. This is grounded in the belief that coverage must be preserved for all who currently have it. Repeal without any effort to replace would leave millions of patients at risk during their most vulnerable times.

We have urged Congress to consider advancing solutions aimed at making our health care system stronger, protecting access and coverage, and exploring new delivery system reforms that have the potential to make care both more affordable and safer.

Our hope is that the Senate will use this opportunity to regroup and work in a bipartisan manner to make the much-needed repairs and refinements, creating a health care system that can stand the test of time.

We ask Congress to extend the Children's Health Insurance Program and vital rural health programs and stabilize the Health Insurance Marketplaces by funding the cost-sharing reduction payments.

America's hospitals and health systems stand ready to help.

Now is the Time for a Bipartisan Healthcare Bill That Will Help Small Businesses: Statement from Small Business Majority Founder & CEO John Arensmeyer

Given last night's news that Senate Republicans do not have enough votes to pass the Better Care Reconciliation Act (BCRA) in its present form, lawmakers should work toward a bipartisan solution that would stabilize the Affordable Care Act (ACA) marketplaces because doing so will greatly benefit our nation's small businesses.

The secretive, exclusive process used by Senate Republicans to craft legislation that would repeal and replace the ACA has been nothing short of disgraceful. The BCRA in its current form is estimated to kick 22 million people off insurance by 2026, stifle entrepreneurial activity and stunt job growth, costing the U.S. economy an estimated one million jobs. It would also phase out the expansion of Medicaid, which covers millions of workers employed by small firms. What's more, the BCRA would have created unbalanced risk pools that would have penalized small employers with older or sicker workers, driving up their costs, and made it nearly impossible for entrepreneurs with pre-existing conditions to access health coverage.

We know there is now talk of considering a "clean" repeal of the ACA, with a possible replacement plan to come at some later date. If lawmakers choose to go down that road, it would be nothing short of a disaster for small businesses. With no viable path forward for the BCRA, repealing major portions of the ACA would return our healthcare system to the state it was in before the healthcare law was enacted-a time when small firms frequently faced double digit premium increases every year, and aspiring entrepreneurs with pre-existing conditions couldn't start their own businesses because they could not afford their own insurance.

We absolutely cannot retreat to that chaotic environment, which is why Democrats and Republicans must now work together to stabilize and strengthen the ACA for the good of America's job creators.

Prior to July 18th

Statement from THA President Craig Becker on Modified BCRA

"Yesterday, the Senate Republican leadership released a modified version of the Better Care Reconciliation Act, and while the plan shows some improvement, it still does not have the best interests of Tennesseans at heart nor the hospitals that serve them.

"Based on our initial understanding of the revised proposal, THA remains opposed to the BCRA. We maintain this position due to the dramatic long-term cuts and structural changes to federal Medicaid funding and the potential for new disruptions to the individual insurance market because of relaxed benefit requirements for insurers. The bill allows insurers to offer plans with limited benefits, which would undoubtedly throw the insurance marketplace into even greater turmoil and increase premiums for older, sicker Tennesseans.

"This is all in addition to elimination of the Prevention and Public Health Fund and maintenance of steep cuts to Medicare reimbursement for providers contained in the Affordable Care Act. We appreciate the efforts in the Senate to soften the blow of the BCRA, but these latest changes still fail to fully address the real challenges facing the individual insurance market. It also continues to take on the daunting and unrelated issue of Medicaid reform, which would be better dealt with in a separate legislative process.

"Now is the time to focus on meaningful reform of the ACA and stabilization of the insurance market, and we continue our commitment to working with Tennessee's senators on such a solution."

David O. Barbe, MD, President American Medical Association

"The revised bill does not address the key concerns of physicians and patients regarding proposed Medicaid cuts and inadequate subsidies that will result in millions of Americans losing health insurance coverage. The additional funding to address the opioid epidemic is a positive step; however, those suffering from substance use disorder have other healthcare needs that are not likely to be addressed if they lose coverage through a rollback of the Medicaid expansion. While stabilizing the individual market is an initial step, more bipartisan collaboration is needed in the months ahead to improve the delivery and financing of healthcare."

Rick Pollack, President & CEO, American Hospital Association

Last month, we urged the Senate to go back to the drawing board after its original proposal included dramatic cuts to the Medicaid program and the loss of healthcare coverage for tens of millions of Americans. If enacted, BCRA would mean real consequences for real people - among them people with chronic conditions such as cancer, individuals with disabilities who need long-term services and support, and the elderly. Unfortunately, in the latest update released today, the unacceptable flaws of BCRA remain unchanged, and there are no significant changes to the massive Medicaid reductions.

Instead of merely tweaking a proposal that would harm our most vulnerable, we again call on the Senate to advance a solution aimed at protecting coverage for all Americans who currently have it. Instead of merely putting forth an update, we again call on the Senate to put forth an upgrade.

Alexander Statement on Revised Draft Senate Healthcare Bill

U.S. Senator Lamar Alexander (R-Tenn.) today released the following statement on revisions to the draft Senate health care bill:

"As I told Bradley Countians last week, my first concern with the Senate healthcare bill is helping the 162,000 low-income Tennesseans who currently have no help with their health insurance and the 350,000 Tennesseans who may not be able to buy insurance in the individual market next year. The revised Senate healt care bill ensures financial assistance for those 162,000 Tennesseans and includes an additional $70 billion to help lower-income Americans in the individual market in Tennessee and elsewhere be able to buy a reasonable health insurance policy."

"I am continuing to review this draft and will see what it costs when the Congressional Budget Office gives its report. Then, I'll stay focused on how it affects Tennesseans as the bill next week goes to the Senate floor, where it will be subject to virtually unlimited amendments. My goals for this bill have not changed since I laid them out in May: 1) rescuing the thousands of Tennesseans and millions of Americans who will be trapped in collapsing Affordable Care Act exchanges with few or even zero options for health insurance in 2018 unless Congress acts; 2) lowering premium costs, which have increased under the ACA law; 3) gradually giving states more flexibility on the Medicaid program, but do this in a way that does not pull the rug out from under people who rely on Medicaid; and 4) making sure those with pre-existing conditions have access to insurance."

Corker Statement on Senate Health Care Legislation

U.S. Senator Bob Corker (R-Tenn.) today released the following statement regarding the Senate healthcare legislation:

"I very much appreciate the way Senate leadership has taken input as they worked to craft this legislation," said Corker. "As we debate the bill next week, every senator - on both sides of the aisle - will have the opportunity to offer amendments and have their voice heard. I am encouraged by the direction of the bill and am hopeful the final product will be one that works better for the American people than what is in place today."

Corker will support the motion to proceed to the legislation next week.

Michele Johnson, Executive Director of The Tennessee Justice Center

"The Senate released their newest take on "repeal and replace" today. Sadly, it's more of the same. Instead of addressing the real needs of Tennesseans, it leaves almost all of us worse off. It still means severe Medicaid cuts, more costly health coverage, windfalls for the wealthy, and taxpayer subsidies for companies selling fake insurance. We are very disappointed and don't see a way to make this bad bill work for Tennessee."

Actuaries Identify Critical Issues in Senate Health Care Bill

June 30, 2017 ... WASHINGTON--The American Academy of Actuaries is drawing policymakers' attention to issues raised by the U.S. Senate majority's health care legislation, the Better Care Reconciliation Act of 2017 (BCRA), in a letter sent to Senate leadership and copied to all other members of Congress and the nation's governors.

"With legislation of this scope affecting millions of people and highly complex markets, assuring stable and sustainable markets is no simple feat," said Academy Senior Health Fellow Cori Uccello. "We provided a nonpartisan, actuarial examination of the BCRA component-by-component, and drew lawmakers' attention to critical issues."

The letter from the Academy's Individual and Small Group Markets Committee and Medicaid Subcommittee states that for a sustainable, stable individual health insurance market, lawmakers should focus on:

  • Continued funding of the cost-sharing reduction (CSR) reimbursements.
  • Enforcement of the individual responsibility penalty (the "individual mandate").
  • Increased external funding through increased premium subsidies or to offset costs for high-cost enrollees.
  • Avoiding legislative or regulatory actions that could increase uncertainty or threaten stability.

The BCRA's Medicaid funding approach affects Medicaid design elements, and the letter urges lawmakers to consider the legislation's impact on the stability and long-term viability of the program, with attention to five key areas:

  • Approaches to setting state caps.
  • Treatment of Medicaid expansion populations.
  • Growth rate methodology.
  • Program flexibility provided to states.
  • Continuing actuarial soundness requirements.

The letter is publicly available online at actuary.org.

Statement from Congressman Jim Cooper (TN-05) on Delayed Vote

"Thanks to calls and protests from Americans - Democrats, Republicans and independents; the elderly, the sick and the poor; religious leaders, community advocates and thoughtful organizers; hospital leaders, doctors and other health care providers; and hard-working, tax-paying, caring Tennesseans - Senate Republicans have delayed a vote on their awful health care bill," Rep. Cooper said. "That's great news, but the fight is far from over, and a bad bill could come back in the future. The Affordable Care Act isn't perfect and we can fix its problems. The best health care plan would be one that can achieve bipartisan support."

Statement from THA President Craig Becker on CBO Score of BCRA

Association Declares Opposition to Legislation

"The release of the Congressional Budget Office's review of the Better Care Reconciliation Act of 2017 affirms one of the greatest concerns for hospitals. With a projected loss of coverage for 22 million Americans, the Senate legislation does not reform healthcare in a way that preserves health coverage.

"Here in Tennessee, uncompensated care provided to the uninsured is a tremendous burden on our hospitals and the CBO score suggests that burden could grow if the BCRA is passed.

"This financial liability on hospitals persists in the face of steep cuts to Medicare provider reimbursement contained in the Affordable Care Act, which are set to remain in place under the proposed legislation. Combined with the long-term funding cuts to Medicaid programs, we fear the BCRA spells doom for healthcare in Tennessee and for the future of our hospitals, especially those in the rural parts of the state.

"Hospitals always will remain committed to caring for the people and communities of Tennessee, regardless of insurance status or ability to pay, but we must recognize the unsustainable circumstances in which these facilities operate. The BCRA only stands to make the current situation much worse."

AMA Releases Results of Telephone Poll on Tennessee Voters' Opinions about ACA & Current Reform Efforts

Link to poll results here

Alexander Statement on CBO's Report on the Draft Senate Health Care Bill

U.S. Sen. Lamar Alexander (R-Tenn.) today released the following statement on the Congressional Budget Office's (CBO) report on the draft Senate health care bill:

"The Congressional Budget Office report is helpful information for every senator to consider as we review the draft Senate bill and look at how it will affect our states. I'm encouraged that CBO says premiums would begin to fall under this bill starting in 2020, especially in states that take advantage of the new flexibility available under the bill. It's important to remember that the alternative to this bill is current law that leaves 162,000 Tennesseans who make less than $12,000 a year without aid to buy insurance, and as many as 350,000 Tennesseans in the individual market facing the real possibility of having zero insurance options next year."

CBO Estimate Shows Senate Health Bill Would Devastate Small Businesses

Statement from Small Business Majority Founder & CEO John Arensmeyer in response to today's Congressional Budget Office estimate on the impact of the Better Care Reconciliation Act, which would cost an estimated 22 million Americans their health insurance coverage.

The Congressional Budget Office (CBO) today released a report on the potential consequences of the U.S. Senate's replacement plan for the Affordable Care Act (ACA), called the Better Care Reconciliation Act (BCRA). Although Senate Republicans seem set on passing this bill regardless of the harm it might cause, the CBO estimate indicates that the BCRA would decimate small businesses by destabilizing the health insurance market, causing premiums to skyrocket and leaving millions of entrepreneurs and small business employees unable to afford coverage.

According to the CBO estimate, the BCRA would result in 15 million Americans losing health coverage in 2018, and a total of 22 million losing coverage by 2026. What's more, the BCRA would greatly destabilize the markets and individual premiums for non-group plans would increase by a whopping 20 percent on average next year.

Since the BCRA allows states to opt out of many ACA requirements, the bill could result in people who are sick being unable to afford the coverage they need. The CBO notes that the BCRA could hurt those with pre-existing conditions because they would only be able to purchase slimmed-down plans with high out-of-pocket costs. This means solo entrepreneurs who get sick could get hit with huge bills, and might lose their businesses.

The ACA absolutely could be improved, but replacing it with the Senate's replacement plan would hinder entrepreneurial activity and stunt job growth. As the CBO report shows, this legislation will make health insurance less attainable and affordable for many entrepreneurs and their employees. It also puts an end to the expansion of Medicaid, which currently covers millions of small business workers.

Rather than a cure for what ails small businesses, it could not be clearer that the healthcare plans offered by Congress this year would be nothing but bitter pills. America's job creators already have enough challenges without lawmakers making it harder for them to access health insurance for their employees and themselves. The CBO's estimate is further evidence that the Senate should scrap its current healthcare framework and take up a new plan that would strengthen the ACA and bring down costs for small businesses.

(For more information on how the BCRA would harm small businesses, and why small firms support the ACA: http://smallbusinessmajority.org/downloads/aca/Senate-healthcare-bill-impact-on-small-biz.pdf)

AMA Announces Opposition to Senate Health System Reform Legislation

The American Medical Association (AMA) today, in a letter to Senate leaders, outlined its opposition to the Better Care Reconciliation Act. Throughout the health system reform debate, the AMA has urged that reforms not result in individuals with health insurance losing access to affordable, quality coverage; that Medicaid, CHIP and other safety net programs be adequately funded; and that key market reforms, such as pre-existing conditions, be maintained. The Senate draft, however, violates many of those principles.

"On behalf of the physician and medical student members of the American Medical Association (AMA), I am writing to express our opposition to the discussion draft of the 'Better Care Reconciliation Act' released on June 22, 2017," the letter begins. "Medicine has long operated under the precept of Primum non nocere, or 'first, do no harm.' The draft legislation violates that standard on many levels."

The full text of the letter is below and can be downloaded in pdf format here:

Dear Majority Leader McConnell and Leader Schumer:

On behalf of the physician and medical student members of the American Medical Association (AMA), I am writing to express our opposition to the discussion draft of the "Better Care Reconciliation Act" released on June 22, 2017. Medicine has long operated under the precept of Primum non nocere, or "first, do no harm." The draft legislation violates that standard on many levels.

In our January 3, 2017 letter to you, and in subsequent communications, we have consistently urged that the Senate, in developing proposals to replace portions of the current law, pay special attention to ensure that individuals currently covered do not lose access to affordable, quality health insurance coverage. In addition, we have advocated for the sufficient funding of Medicaid and other safety net programs and urged steps to promote stability in the individual market.

Though we await additional analysis of the proposal, it seems highly likely that a combination of smaller subsidies resulting from lower benchmarks and the increased likelihood of waivers of important protections such as required benefits, actuarial value standards, and out of pocket spending limits will expose low and middle income patients to higher costs and greater difficulty in affording care.

The AMA is particularly concerned with proposals to convert the Medicaid program into a system that limits the federal obligation to care for needy patients to a predetermined formula based on per-capita-caps. At the recently concluded Annual Meeting of the AMA House of Delegates, representatives of more than 190 state and national specialty medical associations spoke strongly in opposition to such proposals. Per-capita-caps fail to take into account unanticipated costs of new medical innovations or the fiscal impact of public health epidemics, such as the crisis of opioid abuse currently ravaging our nation.

The Senate proposal to artificially limit the growth of Medicaid expenditures below even the rate of medical inflation threatens to limit states' ability to address the health care needs of their most vulnerable citizens. It would be a serious mistake to lock into place another arbitrary and unsustainable formula that will be extremely difficult and costly to fix.

We are also concerned with other provisions of the legislation beyond those directly affecting insurance coverage. The Affordable Care Act's Prevention and Public Health Fund was, according to the Department of Health and Human Services, established to "provide expanded and sustained national investments in prevention and public health, to improve health outcomes, and to enhance health care quality." These activities are key to controlling health care costs and the elimination of support for them runs counter to the goal of improving the health care system. We also continue to oppose Congressionally-mandated restrictions on where lower income women (and men) may receive otherwise covered health care services - in this case the prohibition on individuals using their Medicaid coverage at clinics operated by Planned Parenthood. These provisions violate longstanding AMA policy on patients' freedom to choose their providers and physicians' freedom to practice in the setting of their choice.

We do appreciate the inclusion of several provisions designed to bring short term stability to the individual market, including the extension of cost sharing reductions payments. We urge, however, that these provisions serve as the basis of Senate efforts to improve the ACA and ensure that quality, affordable health insurance coverage is within reach of all Americans.

We sincerely hope that the Senate will take this opportunity to change the course of the current debate and work to fix problems with the current system. We believe that Congress should be working to increase the number of Americans with access to quality, affordable health insurance instead of pursuing policies that have the opposite effect, and we renew our commitment to work with you in that endeavor.


James L. Madara, M.D.

Chief Executive Officer and Executive Vice President


While Centerstone appreciates ongoing attempts to improve our healthcare system, the healthcare bill released yesterday has the potential to result in unintended consequences that will jeopardize the health and wellbeing of some of our nation's most vulnerable populations. As a provider of behavioral health services, we are particularly concerned about the provision that allows states to waive coverage for mental health and addictions treatments, as well as deep cuts to Medicaid. Removing these safeguards will compromise individuals' and families' access to evidence-based care that can help them lead more productive, healthy lives. This creates a sicker population and, ultimately, costs taxpayers more because it shifts costs from healthcare spending to more expensive institutions, such as emergency rooms and jails.

We strongly believe that deliberating, receiving feedback from frontline healthcare providers, and giving policy experts the opportunity to weigh in on the short- and long-term results of the bill for consumers will not only minimize unintended consequences of the legislation, but also will enable lawmakers to cast an informed vote on a bill they can truly stand behind.


"Yesterday's release of the U.S. Senate's Better Care Reconciliation Act of 2017 was a worrisome development for hospitals in Tennessee. This bill, much like the version passed by the U.S. House of Representatives in May, fails to adequately address the healthcare needs of Tennesseans and THA opposes the legislation.

"Under this proposal, changes to Medicaid funding shift a significant financial burden to states by limiting the federal government's funding of Medicaid programs. These changes represent real, long-term cuts to Medicaid and present a major threat for the future of healthcare and hospitals in our state.

"Changes to premium subsidies and the repeal of the individual coverage mandate also put at risk the coverage of more than 200,000 Tennesseans who have gained insurance through the exchanges. Any increase in the uninsured in Tennessee is detrimental to the health and well-being of those Tennesseans and hospitals that already provide uncompensated care at a significant loss, to the tune of more than $1 billion each year.

"Further, the dramatic cuts to Medicare provider reimbursement contained in the Affordable Care Act are preserved in this proposal, while tax cuts to other stakeholders and providers are restored. These cuts are devastating for hospitals in Tennessee and contributed to closure of rural hospitals across the state as others still face uncertain futures.

"As hospitals, we recognize the need for continued reform of America's healthcare system and support looking for meaningful solutions to the challenges our industry faces. However, the legislation introduced today does not meet these needs."


On the same day as the introduction of the Better Care Reconciliation Act of 2017, the Alliance for Aging Research and more than 30 other provider, patient, aging, disability, and health education nonprofit organizations sent a sign-on letter urging U.S. Senate and Senate Finance Committee leadership to "support, and build upon, existing state Medicaid expansion, and to oppose efforts to change Medicaid financing by limiting federal funding to states through per capita caps."

The letter goes on to note: "We are concerned about the negative impact per capita caps will have on all citizens living with chronic disease, but we are writing to draw your attention to how devastating they will be on individuals with Alzheimer's disease and related dementias (AD/ADRD) and their family caregivers."

The letter stresses that "per capita caps will likely increase costs to states for AD/ADRD care. Research cited by the Family Caregivers Alliance shows that when basic assistance for the needs of daily life is not available, frail elders wind up in high-cost settings--notably hospitals and nursing homes--and overall costs increase. Home care services, which help struggling AD/ADRD family caregivers to keep loved ones together, are at greatest risk of major cuts because home care services are optional under Medicaid while nursing home care is mandatory."

Alliance for Aging Research President and CEO Susan Peschin, MHS, states: "Per capita caps would be devastating to people with Alzheimer's disease and related dementias. The proposed changes would force states to cut eligibility, reduce benefits, and lower provider reimbursement, particularly for high-cost enrollees who need substantial services under the program. It is easy to dehumanize health coverage issues and frame them in terms of cost savings. However, when you look through the lens of people with conditions such as Alzheimer's disease, it is harder to deny their real-world impact."

Read the letter here.


"Under the current health care system, families in Tennessee and across our country face rising costs and have limited choices. Congress has a responsibility to resolve these issues and stabilize the individual insurance market, and over the next several days, I will take time to fully review the legislative text and seek input from a wide range of stakeholders across our state. I will make a final decision based on whether this legislation, on the whole, is better than what is in place today."

Tennesseans who wish to read the discussion draft and provide input to Senator Corker can do so at corker.senate.gov


Rick Pollack, President & CEO

From the onset of this debate, America's hospitals and health systems have been guided by a set of key principles that would protect coverage for Americans. Unfortunately, the draft bill under discussion in the Senate moves in the opposite direction, particularly for our most vulnerable patients. The Senate proposal would likely trigger deep cuts to the Medicaid program that covers millions of Americans with chronic conditions such as cancer, along with the elderly and individuals with disabilities who need long-term services and support. Medicaid cuts of this magnitude are unsustainable and will increase costs to individuals with private insurance. We urge the Senate to go back to the drawing board and develop legislation that continues to provide coverage to all Americans who currently have it.


Michele Johnson, TJC Executive Diretor

"We are deeply disappointed that the Senate did not keep their promises to improve the AHCA. Now it appears that the substance of the deeply unpopular House-passed bill is still in the Senate version and that it is about to become law. Because we have journeyed with regular Tennesseans for the last 21 years we know exactly how this bill impacts children, seniors and people with disabilities. This will crush futures and destroy Tennessee communities. Vital and longstanding protections provided by Medicaid, an effective and historically bipartisan program, will be decimated, hurting our most vulnerable populations. The process and language of the bill has been shrouded in secrecy, but we know enough to know what they are hiding: state budgets, rural hospitals and communities, and most Americans will suffer when this bill becomes law. There has been no transparency and no accountability for something this consequential."


"To begin with, the draft Senate healthcare bill makes no change in the law protecting people with pre-existing conditions, no change in Medicare benefits, and increases Medicaid funding-- that's TennCare--at the rate of inflation. Let me repeat: it makes no change in the law protecting people with pre-existing conditions, no change in Medicare benefits, and increases funding for Medicaid--that's TennCare--at the rate of inflation."

Alexander continued, "Here are some other benefits for Tennesseans I see in this draft:

  • Offers healthcare coverage to 162,000 Tennesseans who make less than $12,000 a year, and under the current law, receive zero help buying insurance.
  • Means the 350,000 Tennesseans who buy their insurance in the individual market - these are Tennesseans who don't get their insurance on the job or who don't get it from the government - are more likely to be able to buy insurance next year instead of being in the collapsing Obamacare exchanges where there may be only one option - or even zero options - to buy insurance.
  • Repeals the health insurance tax, which drives up the cost of premiums.
  • Gives the state more flexibility and continues federal cost-sharing, which our state insurance commissioner said will help bring down the cost of premiums.
  • Slows down sky-rocketing premiums, which in Tennessee have gone up 176 percent over four years.
  • Repeals the medical device tax on one of our state's largest exports.
  • Repeals the employer mandate penalty, which should mean that employers should be able to offer employees more choices of insurance at a lower-cost--and about 60 percent of us get our insurance on the job.
  • Ends the tax on individuals who choose not to buy insurance.
  • Provides more money for hospitals that serve low-income Tennesseans who don't have insurance.
  • Provides new funding for opioid abuse, and opioid abuse is a rampant epidemic in our state.
  • Provides new Medicaid funding for mental health to double the number of days of in-patient treatment."

He concluded, "I'm going to continue to review this draft. I'm going to see what it costs when the Congressional Budget Office gives its report. Then, I'm going to stay focused on it next week as the bill goes to the Senate floor - where it will be subject to virtually unlimited amendments - and my focus will be on how it affects Tennesseans."