Tuesday, July 18, 2017

Defeat of health-insurance bill is a relief for many rural health interests, but debate will go on

Provisions that would reduce Medicaid coverage may have helped kill Senate Majority Leader Mitch McConnell's health-insurance bill. Sen. Jerry Moran of Kansas, one of two Republicans whose joint announcement Monday night killed McConnell's revised bill, "faced pressure at home about how the bill would affect Kansas, including its rural hospitals," The New York Times noted. "The Kansas Hospital Association said last week that the latest version “comes up short, particularly for our most vulnerable patients.”

"Moran said he was concerned the bill wouldn't lower overall consumer costs and wouldn't provide adequate protection for those with pre-existing conditions. He also expressed concerns that deep cuts in Medicaid over the next decade could threaten the survival of already struggling rural hospitals and nursing homes," Jim McLean reports for NPR.

Because President Obama was unpopular in rural America, many loyal Republican voters criticized the Patient Protection and Affordable Health Care Act, but it helped rural communities deeply, Jennifer Steinhauer writes for the Times: "This was true for communities ravaged by the opioid crisis, which health care money helped treat; for rural states where hospitals had become all but dependent on increased Medicaid payments that covered the bulk of their patients; and for poor constituents with chronic medical conditions who had come to take it as an article of faith that their insurance companies could not deny them coverage for pre-existing conditions."

Many Republican governors expanded Medicaid under the ACA and have worried in recent months about how to keep their constituents covered if the Senate bill passed. Moderate Republicans such as Susan Collins of the very rural state of Maine, who was one of four to publicly oppose the bill, said she had been inundated by messages from Republican voters who urged her not to support the plan.

McConnell did not follow through on the warning he gave Republicans last month, that if they couldn't pass a comprehensive bill on their own, they would have to join with Democrats to stabilize the market for private health insurance. Instead, he said he would use the bill the House passed May 4 as a vehicle for a repeal-now, replace-later strategy advocated President Trump. But that strategy fell apart Tuesday, as three senators from rural states -- Collins, Shelley Moore Capito of West Virginia and Lisa Murkowski of Alaska -- said they could not support it, the Times reports.

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