Despite revisions, the nonpartisan New Jersey Health Care Quality Institute finds serious gaps in the new version of Trumpcare. Its President and CEO Linda Schwimmer talks with Chief Political Correspondent Michael Aron.
Aron: Linda, is this new Senate GOP health care bill any better than the one that Mitch McConnell presented last month?
Schwimmer: Unfortunately, Michael, it’s not. The changes to Medicaid are very similar to what was proposed about a month ago. There are some significant changes for the individual market, also called the Obamacare market, and those I think for New Jerseyans and nationally make this bill even more problematic.
Aron: Changes like what?
Schwimmer: So, what the Cruz amendment would do, which is really the biggest change to this bill, is rather than having one risk pool where everyone buys in that same risk pool is it sets up two separate pools. One pool would be compliant with the Affordable Care Act, meaning it would have all of the protections that many people are now familiar with, such as not being able to charge people more if they were sick, not being able to exclude somebody because of pre-existing condition. And it would actually allow for the sale of skinny or smaller plans that don’t cover as much and to exclude things because of pre-existing conditions.
Aron: In the market where people get their coverage through their employers, don’t we already have a range of plans, some skinnier than others?
Schwimmer: Well, typically the products that are provided by employers still have to have what is called these 10 essential benefits which include things that a lot of people take for granted.
Aron: Let me stop you there, you’re saying that the 10 essential benefits in Obamacare are also applied now to everybody else who has coverage through their employer? Everybody in the country has to have these 10 things?
Schwimmer: In order for large employers, where there is an employer mandate to be compliant with the Affordable Care Act, they have to provide plans that have the 10 essential health benefits.
Aron: One of those benefits is maternity care. Do men have to pay for maternity care?
Schwimmer: We all pay for insurance and it’s blended together to sort of share the cost.
Aron: So men are paying for maternity leave?
Schwimmer: Men are paying for maternity care, just like women are paying for prostate cancer, absolutely.
Aron: The bill slows the expansion of Medicaid. What was Medicaid expansion? We hear so much about Medicaid expansion, what was it?
Schwimmer: So, states are able to create their own different Medicaid program and all of the state’s programs are a little bit different. But what the Affordable Care Act did was it created an incentive for states to ensure people that are up to 138 percent of the federal poverty level, so they were able to expand the number of people that were covered. Still for the most part, very poor people as well as pregnant women, babies and the developmentally disabled and the elderly. But the federal government paid for almost all of that expansion. It started out as 100 percent federal government money and it slowly dips down to 90 percent.
Aron: If somebody who got on Medicaid as a result of the Affordable Care Act is still on Medicaid and we phase out Medicaid expansion, that person is not going to lose his or her coverage, are they?
Schwimmer: Well, most likely they will. It’s not going to happen immediately, but most of this funding was coming from the federal government that under the proposed bill that is scheduled to reduce down starting in 2021 and phase out.
Aron: It’ll become a block grant at some point?
Schwimmer: So it’s two separate things. We are going to go to a block grant, which is also called a federal capitation, where that’s going to start under this bill in 2020. And then starting in 2021, over three years, the federal government would scale down the expansion population and the funding for that.
Aron: If you got in under the wire, you keep your coverage or you could lose your coverage?
Schwimmer: It depends on a state budget. If you have a state that has a lot money — which I would love to find one. It’s certainly not here in New Jersey. But if you have a state that has the ability to put the funding back in and to maintain it, you might be OK. But for most states, they really rely on the federal government to provide the funding that we need for that expansion.
Aron: It looks like this bill is not going to pass. If Obamacare were to remain the law of the land is that OK with you?
Schwimmer: So, I am not as so sure that this bill won’t pass. I think that there’s still a lot to be determined between now and next week. But if Obamacare was to remain the law of the land, Obamacare still needs fixes, but I think that there is plenty of people, including us at the Quality Institute with our members, there’s plenty of people that are looking at that exact issue. How can we fix Obamacare, how can we make it better for New Jersey and how can we start getting at things like cost, which Obamacare was starting to get out but really didn’t fully tackle — it didn’t even come close to it — and how do we improve quality? And again that’s something that takes time, but is doable given time, given people working together on it.
Aron: Linda Schwimmer, thanks very much for giving us your thoughts on this.
Schwimmer: Thanks, thank you.