Washington (AP) – a key – unsafe problem that brings the progress of President Donald Trump’s immense bill in the congress is particularly discouraging: How can you cut billions from health care without the Americans or hospitals and others who offer care?
The Republicans are fighting to develop a solution to the health problem that has created their package. According to estimates, 10.9 million people would be under the house version of the invoice without health insurance without health insurance. GOP senators have proposed steeper reductions, which some say, go too far.
“The Senate shortlements in Medicaid are far deeper than the house, and I think that’s problematic,” said GOP Senator Susan Collins from Maine.
The senators met behind closed doors and with civil servants of the Trump management when they hurry up to the President before the period of July fourth to end the immense bill. A immense part of the package with its tax benefits and the strengthened border security expenses is essentially collected. However, the size and scope of the health shortlements are among the most hard remaining problems.
It is reminiscent of the summer during Trump’s first term in 2017, when the Republicans had difficulty keeping their campaign promises, lifting and replacing the Affordable Care Act or Obamacare, just to see how the GOP splinters are losing health coverage. This legislation collapsed with the scenes at that time. John McCain threw a thumbs down.
The majority leader of the Senate, John Thune, is determined to avoid this result, to adhere to the schedule and to advance the vote expected until the end of the week.
“This is a good bill and it will be great for our country,” said Thune on Wednesday and sat down for the potential to trigger economic growth and put money into people’s pockets.
It was always expected that the changes to the federal health programs, especially Medicaid, will become a heart of the GOP package, a way to compensate for the costs of providing tax benefits for millions of Americans. Without the congress measures, taxes would enhance next year if the current tax law expires.
The calculated bill achieved a total of around $ 1.5 trillion of savings, a immense part of it, which resulted from changes in health care. The Medicaid program has been dramatically expanded in the 15 years since the law of Obamacare and is now used around 80 million Americans. The Republicans say that this is far too high, and they want to shy away the program to a smaller size that mainly covers poorer women and children.
The democratic leader of the house, Hakeem Jeffries, said the Republicans try “trying to take away the health care of ten million Americans”. Democrats are uniform against what they call “large, ugly bill”.
A immense part of the costs for health care costs would come from up-to-date 80-hour work requirements for those who receive medicaid services, even if most recipients already work.
Another provision, the so-called provider tax, which almost all states serve to a certain extent for hospitals and others that serve medicaid patients, is particularly concerned about potential cuts for rural hospitals.
Senator Josh Hawley, R-Mo. “It depends when we land the plane in rural hospitals,” he said.
States set up taxes to finance Medicaid, mainly by increasing the reimbursements they receive from the federal government. Critics decipher the system as a kind of “laundry”, but almost every state except Alaska uses it to ensure health insurance.
The legislative template adopted in the house would freeze provider taxes at the current level, while the Senate’s proposal goes deeper by reducing the tax that some states can impose.
“I know that the states are dependent on it,” said Senator Roger Marshall, R-Kan. But he added: “Obviously, the provider tax has to disappear.”
However, a number of GOP senators as well as hospitals and other medical providers in their states make forceful concerns that the tax changes to the providers would decimate rural hospitals.
In a plea for the legislator, the American Hospital Association said that the cuts not only affect those who receive health insurance through Medicaid, but would continue to burden the emergency rooms “if they become the family doctor of millions of new people”.
“And worse, some hospitals, especially those in rural communities, could be forced to close overall,” said Rick Pollack, President and CEO of the Hospital Group.
The Catholic Health Association of the United States found in his own letter that Medicaid offers health insurance protection for each of five people and almost half of all children.
“The proposed changes to Medicaid have devastating consequences, especially for those in small towns and rural communities, in which Medicaid is often the main source of health insurance,” said sister Mary Haddad, President and CEO of the group.
The senators try to develop a solution to the problem and consider creating a rural hospital fund in order to compensate for the lost Medicaid money.
GOP senators spread a proposal to water 15 billion US dollars for the establishment of a up-to-date rural hospital fund. But several senators said that it was too high, while others said it was inadequate. Collins has suggested that the fund be set at 100 billion US dollars.
“It won’t be that big, but there will be a fund,” said Thune.
Hawley, who belonged among the most pronounced cuts in healthcare, said that he is interested in the Rural Hospital Fund, but has to learn more about how it would work.
He also expressed concerns about a up-to-date $ 35 payment of $ 35, which could be charged for those with Medicaid, which could be charged both in the representation of the house and in the versions of the Senate of the Act.
“Getting the fund is good. It is important, one step forward,” said Hawley. But he asked: “How does the fund actually sell the money? Who brings it to hospitals? … Or will it just be something that exists on paper?”
A up-to-date analysis of the White House for Economic Advisor Economic Council estimates that the package over 10 years would lead to a reduction in deficit reduction of up to 2.3 trillion dollars, a significantly different assessment of other analyzes. In contrast, the vigorous analysis of the impartial congress office of the Budget of the Congress in the next decade estimates an enhance in deficits by $ 2.8 trillion.
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Kevin Freking, Mary Clare Jalonick, Joey Cappelletti and Fatima Hussein, contributed to this story.
