"The Senate 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 American Medical Association (July 14, 2017)
SIGN ON LETTER
To Tennessee’s Senators and Members of Congress:
We write to you personally - as doctors, as nurses, as health professionals, and as Tennesseans and as citizens - to urge you to do the right thing for the health and wellbeing of our patients and of all Americans.
Various bills, and revisions of bills, have been proposed in Congress to radically change federal policy affecting our healthcare system. While details differ, and further revisions may emerge, the core elements of the legislation remain consistently disturbing. Their common effect is to reduce care and increase costs for those who need it the most.
Congress should not weaken consumer protections in the Affordable Care Act that protect people with pre-existing conditions and make coverage affordable. We must not go back to the days when insurers could charge more, exclude needed services or deny coverage altogether based on a person’s medical history, or even on their gender. Nor should Congress adopt legislation that will make health insurance more costly to anyone, or reduce its benefits so that meaningful coverage is, in effect, unaffordable. Yet, in various ways, all of the pending proposals have those effects.
According to the non-partisan Congressional Budget Office, the American Health Care Act passed by the House of Representatives will leave 23 million more Americans uninsured. The Senate’s Better Care Reconciliation Act will increase the number of uninsured by 22 million. CBO estimates that the AHCA will cut $834 billion from Medicaid, the nation’s health care safety net, while the BCRA will cut Medicaid by $772 billion. All versions weaken or eliminate consumer insurance protections. All dilute coverage and increase costs for those with the greatest health care needs. Projected job loss exceeds 1 million jobs under any version of the legislation.
Any legislation that caps the federal contribution to Medicaid will impose ever increasing cost burdens on the state. CBO notes that, in the case of the BCRA, the effect will be to cut Medicaid by 35% over two decades. Initial reductions to TennCare would exceed $400 million per year, a devastating amount but only a fraction of much worse cuts to come in later years. When state officials are forced to adjust to the reduced funding, they will have no choice but to cut the most expensive services and patients. Unfortunately, that means the most vulnerable patients will bear the brunt of the federal cuts, because their care is the costliest.
Medicaid provides essential coverage for half of all births and half of all children in Tennessee, including the sickest children with serious conditions like cancer. In addition, Medicaid covers nearly two thirds of our frail elderly nursing home residents. Medicaid is also the primary source of coverage for people of all ages with severe disabilities. As health professionals, we know all too well that cuts to services for these vulnerable patients will cause enormous human suffering and will cost some people their lives.
Medicaid cuts affect everyone, because Medicaid provides critical funding for the health care infrastructure on which we all rely. For example, Medicaid is a major source of funding for hard-pressed rural hospitals and nursing homes. Experts warn that Medicaid caps or block grants will force many of those facilities to close, impairing access to care for people who live in those communities. Medicaid also provides coverage for over half of the patients in Tennessee’s children’s hospitals, and federal Medicaid reductions will have a devastating impact on our ability to care for the state’s sickest children.
Medicaid is the primary source of coverage for treatment of mental illness and addiction, and cutting it now will cripple efforts to combat the growing opioid epidemic. Proposals to mitigate those effects by providing targeted federal funding for addiction treatment cannot compensate for patients’ loss of Medicaid. Medicaid provides a comprehensive package of medical and behavioral health services, which are essential to effectively treat people suffering from addictions. The majority of people with addictions have co-occurring medical or mental conditions that in many instances led to addiction in the first place. They require integrated care; services that address only their addiction will generally be ineffective and, at best, still leave other urgent medical or behavioral health needs untreated.
We respectfully urge you to oppose any legislation that:
- causes people to lose coverage,
- diminishes coverage or increases costs for people with medical or behavioral health conditions,
- reduces federal funding for the extension of Medicaid to people living in or near poverty, depriving Tennessee of the opportunity to join 31 other states in covering these working families,
- caps or cuts the traditional Medicaid program
Current proposals, which would have all of these unfortunate effects, are opposed by respected nonpartisan professional and patient advocacy organizations, and by a large and growing percentage of the American people. These deeply flawed bills are the products of a closed process that failed to consider the views of health care professionals, patients or health policy experts.
As doctors, nurses, and health professionals, we have taken an oath to put our patients first, and to “do no harm.” We ask you to do the same, and we stand ready to help you in your efforts to enact reforms that will truly advance the health and wellbeing of all Americans.