Pennsylvania Sen. Bob Casey Jr., D-Scranton, on Monday delivered a message to the heart of Trump country:
More than 180,000 people living in rural Pennsylvania would lose their health care coverage under the health care plans proposed by Republicans in Washington, D.C., according to Casey. The loss of Medicaid dollars also would hit health care jobs.
Casey, spending an hour at the Fulton County Medical Center, spoke to staff and residents and toured the expanding center.
Casey, Pennsylvania’s senior senator, talked about tweaking the Affordable Care Act, rather than repealing it. He said that he hoped the latest GOP plan would never get past the procedural vote.
He had numbers for Fulton County -- 1,149 residents got health care insurance under the Affordable Care Act exchanges and Medicaid expansion.
That’s almost 8 percent of the county’s population.
Fulton County has been a strong supporter of Donald Trump. Trump won nearly 84 percent of the vote in 2016 presidential election. Republican Pat Toomey, the state’s junior senator, saw similar support in his bid for re-election. Toomey helped draft a Senate bill to replace the ACA.
Casey said he and Toomey have not discussed the issue because they have a basic disagreement about Medicaid.
Casey for weeks has hammered away at the GOP health care plans with data specific to individual counties in Pennsylvania. The Better Care Reconciliation Act plan passed by the House would have cut health care to 640 Fulton County residents. About 53 health care jobs in the county would have been lost by 2026.
That’s about 10 percent of the FCMC staff. The center employs about 500 people, 250 full time. It’s the county’s second-largest employer.
About 16 percent of the FCMC budget comes from Medicaid revenues, according to Casey’s data from the Senate Joint Economic Committee and Senate Special Committee.
Jason Hawkins, CEO of the medical center, said that after the ACA was enacted the number of uninsured patients coming to the emergency room went from 14 percent to 4 percent. That’s a decline of about $100,000 in free care.
Should the cost of caring for the unemployed increase, “it would have an effect on employment,” Hawkins said.FCMC is one of Pennsylvania’s 68 rural hospitals.
Casey asked what Republicans will say to the 180,389 rural Pennsylvanians who would lose Medicaid coverage under the GOP plans. How will they explain the tax cuts for the super rich in the same bill that scales back Medicaid?
“I think we ought to try to move forward on matters that we could work together on -- lower costs, lower premiums -- and do it in a bipartisan way, but the only way we can get there is to stop the legislation that’s in front of us,” Casey said.
A Senate vote on some measure could come as early as Tuesday.
In Washington on Monday, Trump urged Republican lawmakers to repeal and replace the “big, fat, ugly lie” of Obamacare (ACA) as they had promised for years.
“Obamacare has broken our health care system,” he said. “It’s broken. It’s collapsing, it’s gone, and now it is up to us to get great health care for the American people.”
Two House versions and two Senate versions, that the GOP previously introduced, would cut health care coverage to about 41 million people in 2018, according to the nonpartisan Congressional Budget Office. A Senate proposal to repeal the ACA outright would leave 43 million without coverage. Within eight years the numbers would approach or exceed 50 million.
The plans would cut Medicaid by about $800 billion over the next decade.
If the ACA were left alone, about 26 million initially would lose coverage and 28 million by 2026, according to the CBO.
Trump has threatened to undermine the ACA, if Congress fails to repeal it.
“I’m hoping he was using political rhetoric,” Casey said.
Toomey said he was disappointed the Senate has failed to repeal the ACA.
"Obamacare is failing,” Toomey said. “In Pennsylvania, Obamacare premiums are up 120 percent and 40 percent of our residents are limited to one insurer on the exchange. Families are still in dire need of relief. Meanwhile, Medicaid is fiscally unsustainable as its costs continue to grow faster than our economy.
"I intend to vote to proceed to a full Obamacare repeal bill that would take effect in two years so that Congress can use this time to craft a legislative replacement and move toward a consumer-driven health care system.”
Casey said that uncertainty over the ACA’s future has hurt the program.
The ACA also needs repair, he said. Some places have too little competition. Some have premiums that are too high.
A start toward a bipartisan resolution would be the discussion of continuing cost-sharing reduction payments that would lend certainty to the ACA coverage. Cost-sharing reduction payments are discounts that lower the amount an individual pays for deductibles, copayments and coinsurance.
Trump has threatened to withhold the subsidies.
“If we call ourselves a great county we can take care of people,” Casey said. “One of ways we take care of people is to make sure they have Medicaid. You can’t call yourself a great country if you’re pushing people off the cliff when it comes to health care.”
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