Senator Susan Collins a pivotal voice and powerful health care vote

MAINE VOICES
Sen. Susan Collins is again poised to be a crucial vote on health care: Rejecting the latest Senate bill would protect our health and our communities- Dr. Sam Zager opinion represents Maine health care providers and Maine Providers Standing Up for Health Care.

MaineWriter preface:

Senator Susan Collins is a strong advocate for the most poor and frail in our nation and in Maine. Her family has experienced the impact of having loved ones who care for their relatives when they need expert long term care. Now, with her knowledge about how insurance coverage is managed, coupled with an in depth understanding of Medicaid and Medicare regulatory oversight, she has the capacity to apply her experience to protect those who cannot speak for themselves. Please opposed the Graham-Cassidy bill, it's a bad idea (as reported in the September 20, Washington Post).

In fact, all 50 state Medicaid directors have opposed the Graham-Cassidy Republican repeal bill to destroy the Affordable Care Act, a cruel piece of legislation now being considered by the Republicans. It's a very, very sad time in America, when politics has completely taken over the risk management of our national health care policies. In the Republican's resurrected attempt to repeal the Affordable Care Act (ACA), the cruel GOP bill will cut Medicaid by imposing a per-enrollee caps on services. 

This is health care rationing.  Moreover, somebody will have to decide when to cut care for very ill people, if this terrible bill passes. Pro-life advocates are hiding in the rafters, but they should be shaking the Congress to protect Medicaid.

It's outrageous to cap Medicaid beneficiaries' health care costs, because, for those who need the coverage, the medical caps will cause them mortal harm. We're talking about neo-natal premature babies, children born with heart anomalies, disabled people, patients with neurological diseases, the mentally ill and frail elderly. You might as well cut the oxygen to the people with chronic and acute care needs, as to put a cap on their medical care costs, by capping Medicaid. 

Obviously, the purpose of these disastrous cuts are so that states will have some change left on the table after they receive their Medicaid money for them to use for subsidies to put towards those who will need premium subsidies to cover pre-existing conditions.

Here is an opinon "echo" from Dr. Sam Zager, who represents Maine Providers Standing Up for Health Care, published in "Maine Voices":

PORTLAND, Me- The U.S. Senate is planning to vote next week on the health bill sponsored by Sens. Lindsey Graham, R-S.C., and Bill Cassidy, R-La. Many observers consider it the Republicans’ last chance to repeal the Affordable Care Act before a Sept. 30 deadline. Although Sen. Susan Collins has yet to take a firm public stand, she is again poised to be a crucial opposing vote. Rejecting this bill would protect our health, our communities and the normal order of the Senate.

One similarity between Graham-Cassidy and its predecessors is the shoddy legislative process. Without any hearings or opportunities for public comment, Majority Leader Mitch McConnell, R-Ky., is bringing a hastily concocted bill to an unfortunate partisan vote.

“Bipartisan support – that’s what we really need when we’re tackling an issue as difficult as health care,” Sen. Collins told MSNBC’s Chuck Todd on June 22. The Congressional Budget Office (CBO) said this week that it would need several weeks to fully “score” the bill. This rushed vote, therefore, means that senators will likely not know how many of their constituents might lose their health insurance as a result of Graham-Cassidy.

In addition to process problems, Graham-Cassidy has grave flaws in substance. A core feature of the bill is a reduction in federal funds allocated to health care, especially for low-income Americans and other vulnerable groups.

The Robert Wood Johnson Foundation and Kaiser Family Foundation each independently estimate about 6 to 8 percent less federal spending for health coverage nationally in the first seven years under Graham-Cassidy (2020-2026). When combined with the proposed Medicaid caps per enrollee, $160 billion less would flow from Congress to the states.

Even with the bill’s block grant, Maine would lose $54 million under Graham-Cassidy. After 2026, Graham-Cassidy’s block funding would plummet to zero, so our state would lose $745 million annually starting in 2027.

What do these numbers mean in real terms, for real Mainers? 

The Graham-Cassidy cuts would ripple through our health infrastructure and cascade through our communities.

More hospitals and federally qualified health clinics would cut back staffing and services, or close completely. Fewer employers or workers would be inclined to relocate to Maine or stay here. Workforce sizes would then diminish, and the tax base would suffer. Education investment would decrease, with a subsequent decrease in workforce readiness.

The overall perception that Maine communities are declining would further deter investment in our state, and the cycle would repeat.

This health bill would, ironically, be terrible for health. It would significantly weaken the ACA’s guarantees regarding pre-existing conditions. It would cut treatment for opioid and other substance dependence. It would defund Planned Parenthood, thereby restricting access to contraception and cancer screening (federal law already prohibits Medicaid from funding abortions). It would eliminate the employer and individual mandate, further destabilizing insurance marketplaces in Maine and other states.

In addition to these rule changes, cuts to Medicaid would greatly harm the 34 million children, 27 million low-income non-senior adults, 10 million disabled Americans, 6 million seniors, 2 million expectant mothers and 1.75 million veterans who depend on it for health insurance.

Health insurance matters, and lack of it confers significant health risks. Last month, the New England Journal of Medicine published a review of many high-quality studies from the previous decade. 

Having insurance enhances financial security and reduces bankruptcies; improves access to primary care; improves medication adherence for chronic conditions; improves self-reported health, a validated measure of the risk of death, and improves mental health outcomes, such as depression.

Moreover, several studies over the past 25 years show lower death rates among people with insurance. One study found that states that expanded Medicaid had 6 percent lower mortality rates over five years, compared to neighboring non-expansion states. Two other studiesconcluded that providing health insurance to 1 million people would save around 2,000 American lives annually. This is consistent with international data, which show that countries with universal health coverage tend to far outperform the United States in health outcomes, at a fraction of the cost per person.

Susan Collins demonstrated incredible leadership this summer during the prior attempts to repeal the ACA. 

In June’s MSNBC interview, she said, “I cannot support a bill that is going to result in tens of millions of people losing their health insurance.” She withstood withering criticism from the president and others in her party, but held her ground. For the sake of our communities, our health and our lives, we hope Sen. Collins will do the same next week.

Sam Zager, M.D., of Portland is a family physician and a member of Maine Providers Standing Up for Healthcare.