Experts Explain How GOP Repeal Of The ACA Will Hurt Americans

››› ››› CAT DUFFY

Cable networks have hosted a variety of health care experts to discuss the negative impact that the Republican health care bill and repeal of the Affordable Care Act (ACA) will have on different aspects of the American health care system, including coverage, health care costs, Medicaid, and women’s health care.

Sylvia Burwell - Former HHS Secretary

Michael Botticelli - Former Director of the Office of National Drug Control Policy

Andy Slavitt - Former Acting Administrator for the Centers of Medicare and Medicaid Services at HHS

Bruce Siegel - President of America's Essential Hospitals

Doug Elmendorf - Former CBO Director

Pamela Cipriano - President of the American Nurses Association

Kathleen Sebelius - Former HHS Secretary

Nitrin Damle - President of the American College of Physicians

Hal Lawrence - CEO of the American College of Obstetricians

Cecile Richards - President of Planned Parenthood

The GOP Released Its Health Care Bill, The American Health Care Act

Vox: The AHCA Will Provide “Much Lower Subsidies,” Roll Back “Much Of The [ACA’s] Insurance Expansion,” And “Cut Medicaid.” Vox’s Sarah Kliff wrote a brief “explainer” on the American Health Care Act, highlighting the major changes the proposed law will have on the health care system. She notes that it “will roll back much of the [Affordable Care Act’s] insurance expansion” by making coverage “less accessible to low- and middle-income Americans.” Kliff outlined potential cuts to Medicaid and explained that “AHCA provides much lower subsidies” than the Affordable Care Act (ACA) does. From the March 7 article:

The American Health Care Act is Republicans’ plan to repeal and replace Obamacare.

[...]

The AHCA gets rid of some popular parts of Obamacare, too. It will roll back much of the health law’s insurance expansion, which currently covers about 20 million people. It does this by making the two big sources of coverage under the law — Medicaid and private individual insurance — less accessible to low- and middle-income Americans.

In private insurance, AHCA provides much lower subsidies for those who buy coverage on the individual market — especially people who are low-income. The Kaiser Family Foundation estimates that, on average, the subsidies in this plan are 36 percent lower than those in current law. This means that it would become harder for people who earn about $20,000 or $30,000 a year to afford coverage if they don’t get it at work.

[...]

AHCA would keep the Medicaid expansion but only until 2020. At that point, states would have to stop enrolling people and anyone who fell off the program — perhaps because their income went up, or they simply forgot to enroll — would not be allowed back on.

AHCA changes the rest of Medicaid, too. Right now, the federal government pays a certain percent of every Medicaid enrollees’ bills no matter how high they go. AHCA would change that: It would have the federal government give states a lump sum for each person in Medicaid, meaning states could run out of money for especially high-cost patients.

We’re still waiting for more analysis on how much this particular provision could cut Medicaid. A lot depends on key details, like how big that lump sum is and how quickly it would grow. [Vox, 3/7/17]

MSNBC And CNN Have Hosted Experts To Describe The Impacts Of The AHCA

Former HHS Secretary Sylvia Burwell: “Instead Of Taking Us Forward On The Issues Of Making Sure That People Have Health Coverage,” The GOP Bill “Takes Us The Other Direction.” During an interview with MSNBC’s Andrea Mitchell, former Health and Human Services (HHS) Secretary Sylvia Burwell denounced the Republican health proposal, saying that “it's disappointing, because instead of taking us forward on the issues of making sure that people have health coverage, on issues of making health care more affordable, and making sure that quality of benefits are maintained, on all three of those fronts, this takes us the other direction.” Citing the CBO report, she outlined that the proposal “would increase premiums by 25 percent” and “would take away the enforcement of certain essential health benefits, things like making sure maternity is covered.” Burwell condemned the impact the bill would have on women’s health care in particular, calling it concerning that the GOP would cut funding to “one of the providers that provides services in terms of preventative care -- that’s, well-women visits, that’s kinds of cancer screenings for women, that’s contraception and other types of care” From the March 7 edition of MSNBC’s Andrea Mitchell Reports:

ANDREA MITCHELL: In your initial look at what they are revealing, how would it affect Americans, how would it affect those who are less able to afford health insurance under the new plan?

SYLVIA BURWELL: So, in the initial look, which is a complicated and difficult one, because I think as most folks know, this was a bill that was done in secret, and even Republicans weren't able to see it before it appeared, but in the initial look at it, what it does is it's disappointing, because instead of taking us forward on the issues of making sure that people have health coverage, on issues of making health care more affordable, and making sure that quality of benefits are maintained, on all three of those fronts, this takes us the other direction. With regard to the issue of affordability, because they have taken away many of the tax issues that were for upper-income Americans as well as corporations, money goes away, and then money is taken away from the subsidies and tax credits that people already received. So their health care will become more expensive. We know that getting rid of the individual mandate, the only part of this bill that has been previously analyzed by the Congressional Budget Office, the nonpartisan Congressional Budget Office, it said that that would increase premiums by 25 percent. So this is something that's moving us in the wrong direction with regard to coverage. It gets rid of Medicaid expansion, with regard to affordability it increases premiums and deductibles. And also with regard to making sure that you maintain the benefits -- we know that the Medicaid changes it proposes would take away the enforcement of certain essential health benefits, things like making sure maternity is covered or things like making sure that there is help for people with behavioral health issues like opioids.

[...]

MITCHELL: I want to ask you about Planned Parenthood, because there's also a measure to strip funding for Planned Parenthood, given the women's health benefits in Planned Parenthood that are funded because separately and nonfederal funding planned parenthood provides a portion coverage for women. Can you analyze how that would impact women in many states?

BURWELL: Again, focusing on what I think most folks when I’ve been out in the country have talked about, which is affordability, access and quality, and this issue, because the funding does not go for -- there is no federal funding that ever goes for abortion and what Planned Parenthood, when they receive funding they receive funding for preventative care services that they have provided to people in low-income communities. And the idea that we are going to not fund one of the providers that provides services in terms of preventative care -- that’s well-women visits, that’s kinds of cancer screenings for women, that's contraception and other types of care that they will not be funded -- is something that I think is concerning to many folks and especially women. [MSNBC, Andrea Mitchell Reports, 3/7/15]

Former Director Of The Office of National Drug Control Policy Michael Botticelli: The ACA’s Progress In Fighting The Opioid Epidemic “Will Be Completely Undone” By The GOP Health Care Bill. MSNBC’s Kate Snow interviewed Michael Botticelli, the former director of the Office of National Drug Control Policy, about the opioid epidemic in the U.S. and the gains made by the ACA in combating it. Botticelli explained that “fundamental to keeping people alive is making sure that people have adequate access to high-quality treatment” and the GOP’s bill “will have a devastating impact on people's ability to get that care that they need.” He emphasized the positive gains made under the ACA, citing “dramatic increases in access to substance use treatment services for those states who have expanded Medicaid.” Botticelli outlined how the Medicaid expansion “ensured that people had access to affordable health care for substance use disorders” and noted that the ACA’s essential health benefits included “access to addiction treatment.” He emphasized that “this will all go away under the Republican plan” and that all the gains made under the ACA “will be completely undone if this bill is to take effect.” From the March 14 edition of MSNBC Live:

KATE SNOW (HOST): We know -- I think about 2 million people, if I have my numbers right, are suffering from opioid use and addiction. How many of those folks were getting treatment, and how many are you worried will not get treatment under the new plan?

MICHAEL BOTTICELLI: Sure. As you discussed, this opioid epidemic has been having a devastating impact across this country. Not only do we see about 2 million people who are addicted to opioids, but at last federal count we have 140 people who are dying every single day of a drug overdose. Ninety of those are linked to prescription drugs and heroin.

SNOW: That's unbelievable.

BOTTICELLI: Fundamental to keeping people alive is making sure that people have adequate access to high-quality treatment. And clearly this bill will have a devastating impact on people's ability to get that care that they need, particularly the Medicaid expansion population, where we have seen, quite honestly, dramatic increases in access to substance use treatment services for those states who have expanded Medicaid. So this is likely to have just a devastating impact across the country in terms of the mortality that we see. I think the other important part, Kate, is that -- I've talked to law enforcement officers across this country, and they thoroughly understand the role that untreated addiction plays in driving up crime. So not only are we likely to see dramatic increases in death associated with heroin and prescription drugs, but significant spikes with crimes in many communities across the country.

SNOW: So it's the Medicaid expansion and the lack of continuing that expansion that you are most worried about? Or what is it specifically that makes you think -- because I'm sure the administration would say, "No, no we are still gonna offer people treatment options"?

BOTTICELLI: Sure, so I think there are a number of things, but particularly with the Medicaid expansion population. It did a number of things. One, it ensured that people had access to affordable health care for substance use disorders, and it made sure that essential health benefits, that addiction treatment, was one of those benefits. So this will all go away under the Republican plan that we see here. I think the other important point, Kate, is that people with opioid addictions not only need access to addiction treatment but they also see -- we've also seen dramatic increases in viral hepatitis, we've seen spikes in HIV in many places across the country. So not only do they need access to addiction treatment, but they really need comprehensive health care. So just to say that we're going to increase capacity for addiction treatment is insufficient.

[..]

BOTTICELLI: I think we have been seeing progress that we've been making in terms of reducing the volume of prescription drugs that are being prescribed in the United States. We've seen dramatic increases in prescription drug misuse go down. And again in those states, particularly those that have expanded Medicaid, that have been hardest hit, we've seen dramatic increases to treatment. In Kentucky, for example, that expanded Medicaid, they saw a 740 percent increase in substance use treatment services associated with Medicaid expansion. So again, I think we are beginning to see some level of progress here, but all of that will be completely undone if this bill is to take effect. [MSNBC, MSNBC Live, 3/14/17]

Former CMS Administrator Andy Slavitt: The AHCA “Cut[s] Medicaid By About 25 Percent” To Pay For “An $800 Billion Tax Cut For Corporations And Wealthy Americans.” Andy Slavitt, the former acting administrator for the Centers of Medicare and Medicaid Services at HHS, explained that “the simplest way to look at” the GOP health bill is that “we’re cutting Medicaid by about 25 percent” and noted that these cuts pay for “an $800 billion tax cut for corporations and wealthy Americans.” When MSNBC host Lawrence O’Donnell asked about White House press secretary Sean Spicer’s assertion that Medicaid beneficiaries are denied access to care, Slavitt debunked the claim. He noted that Medicaid is one of the “most highly valued programs in our country” and explained that Medicaid and Medicare reduced the number of seniors living below the poverty level from “one in three” to “less than one in 10.” From the March 13 edition of MSNBC’s The Last Word with Lawrence O’Donnell:

LAWRENCE O’DONNELL (HOST): Andy Slavitt, let’s get your reaction to the Medicaid piece of what you’re hearing in this proposal.

ANDY SLAVITT: Yes, well, thank you, Lawrence. I think the simplest way to look at this proposal, and the CBO verifies this, is we’re cutting Medicaid by about 25 percent. And to remind everybody what Medicaid does, Medicaid is a program that takes care of kids, low-income people, seniors in long-term care, and people with disabilities. That’s it. So, when you cut 25 percent from that, you really leave governors in states with very, very stark choices over which of those sets of people aren’t going to get benefits. Because states, as we know, have to balance their budgets every year. And with a cap and a cut, and I want to repeat that, they’re not just cutting by 25 percent -- but then they’re saying, we’re going to limit the growth of Medicaid going forward. And of course as I think you’ve said earlier, and as Doug said, that’s all to pay for about an $800 billion tax cut for corporations and wealthy Americans.

[...]

O’DONNELL: Andy Slavitt, you’ve overseen the Medicaid program in particular. Today, Sean Spicer was saying that people on Medicare cannot get physician services because physicians turned down Medicare. But he was stressing that they turn down Medicaid patients all the time. What does that -- what’s the truth of that? What does that mean for Medicaid patients?

SLAVITT: Well, the truth is that the Medicaid program and the Medicare program are two of the most highly valued programs in our country. You know, prior to Medicare and Medicaid, one in three seniors in this country lived below the poverty level. One in three. Today, because of Medicare and Medicaid, that’s less than one in 10. These are really phenomenal programs, they’ve changed the country. And they’ve done that in ways that have glowing popularity. I think over 70 percent for Medicaid, close to 90 percent for Medicare. And that wouldn’t happen if people weren’t getting taken care of. And I think we have to remember that half the kids in this country that are born are paid for through the Medicaid program. And we have to really decide as a country if we really want to pass legislation that strips away all the funding to take care of all the kids that are born in this country -- they’re born healthy -- in order for this very large tax cut. [MSNBC, The Last Word, 3/13/17]

President Of America’s Essential Hospitals Dr. Bruce Siegel: “State Flexibility Is Great, But If You Take Out $900 Billion From The Medicaid Program … That’s Devastation.” During an interview with MSNBC’s Craig Melvin, Dr. Bruce Siegel, the president and CEO of America’s Essential Hospitals, said he was “stunned” by the CBO report when he “saw 24 million would lose coverage” under the GOP’s health bill. He predicted that the bill’s Medicaid cuts would cause “rationing” because “when we say … we're going to take a quarter out of the Medicaid program, what we're really saying is, well, you may be able to pay for old folks in nursing homes or you may be able to pay for people to get a transplant but probably not both.” Siegel debunked right-wing media’s talking point about Medicaid caps boosting state flexibility, noting that “state flexibility is great, but if you take out $900 billion from the Medicaid program and basically block-grant it, that's devastation.” From the March 15 edition of MSNBC Live:

CRAIG MELVIN (HOST): Dr. Siegel, let me turn to you because your association, you guys said you were deeply concerned about the legislation in its current form. And that was a statement that was issued before the CBO report even came out. Did that report make you more concerned, less concerned?

BRUCE SIEGEL: Oh, that report, Craig, made us much more concerned. We already had fears that many people would lose coverage under the bill now being discussed in Congress. But when we saw 24 million people would lose coverage, we were stunned. We were stunned that we would be looking at $900 billion in cuts to Medicaid -- really a quarter of the program going away, which we think would lead probably to hospital closures around our country in some hard-hit areas and also lead to, frankly, rationing. When we say to folks, hey, we're going to take a quarter out of the Medicaid program, what we're really saying is, well, you may be able to pay for old folks in nursing homes or you may be able to pay for people to get a transplant but probably not both and we're going to have to decide who gets what. It was really sort of a stunning report and was even worse than we expected.

MELVIN: Dr. Siegel, as you know, a number of folks inside the GOP have said that, first of all, Medicaid expansion in its current form is unsustainable and that it would be a better idea to block-grant money to the states and allow states to essentially run Medicaid in those states. Dr. Siegel, is that something that would be feasible, in your eyes?

SIEGEL: No. It's simply not true that Medicaid expansion has been a bad idea. It's been a great idea, and as Sister Carol mentioned, millions of people have gotten health care for the first time in our country because of that. Let me give you just one example we forget about. Many parts of our country, places like Ohio or Kentucky, parts of Pennsylvania, Arkansas, have been dealing with the opioid crisis -- the huge problems we've had with addiction from legal opioid drugs, which have just really ravaged many of our communities. Because of Medicaid expansion, hundreds of thousands of people now are getting addiction treatment and mental health treatment that is helping them to fight that. If you roll that back, which is what this bill does, then you're going to lose that benefit and that opioid crisis will continue and accelerate across the country. I mean, state flexibility is great, but if you take out $900 billion from the Medicaid program and basically block-grant it, that's devastation. [MSNBC, MSNBC Live, 3/15/17]

Former CBO Director Doug Elmendorf: “Older Americans Would Have Higher Premiums And Pay More In Deductibles And Co-Payments When They Need Care.” During an interview, former director of the Congressional Budget Office (CBO) Douglas Elmendorf agreed with MSNBC host Lawrence O’Donnell’s assessment that “older people’s premiums will definitely go up,” explaining that the “change in the age structure of premiums” will allow insurers to charge “five times as much for older Americans as younger Americans.” He noted that the “reduction in the number of health care services ... covered by the insurance plans” as a result of the GOP bill will cause “people’s out-of-pocket payments” to increase. From the March 13 edition of MSNBC’s The Last Word with Lawrence O’Donnell:

LAWRENCE O’DONNELL: I want to go to this point about premiums and there’s an indication in the CBO report that in the long run of this legislation, some premiums on the individual market would go down. Or I shouldn’t -- put this correctly, they would not increase as much as they would increase under the Affordable Care Act. But the report says in that spot that this is partially because of the change in the requirements for the health care plans that would be sold. And Doug Elmendorf, what they mean by that is, these plans will be cheaper because they will have less benefits in them, and also young people can be charged a lot less for these health plans and that older people will be charged much, much more. The older people’s premiums will definitely go up higher.

DOUGLAS ELMENDORF: Right, so there are two pieces of this. One is, as you say, that because of relaxation of rules in this legislation, health insurance plans would cover a smaller share of people’s total costs. So part of the reason that premiums would go down is because people’s out-of-pocket payments would go up. That doesn’t make them better off on average. Those who don’t get sick that year will be better off with lower premiums. Those who do get sick would pay more out of pocket. So on average, this reduction in the number of health care services, the amount of health care covered by the insurance plans, would lower premiums, but people would pay some of that out of pocket themselves. In addition to that, there’s a change in the age structure of premiums. Under the Affordable Care Act, insurers can only charge older Americans three times what they charge younger Americans for these plans and insurance exchanges. Under this legislation, insurers could charge five times as much for older Americans as younger Americans. That will tend to push up health care insurance premiums for older Americans substantially. So, some younger Americans would have lower premiums under this legislation. But older Americans would have higher premiums and pay more in deductibles and co-payments when they need health care. [MSNBC, The Last Word, 3/13/17]

ANA President Pamela Cipriano: The GOP Plan “Will Really Just Destroy The Availability Of Insurance And Access To Services.” On MSNBC Live, Pamela Cipriano, the president of the American Nurses Association, criticized the proposals to wind down the Medicaid expansion, because “millions of Americans … will lose [their] coverage. And these are some individuals who are least able to pay for any kind of coverage on their own.” She extolled the gains made by the Affordable Care Act and emphasized that the GOP bill “will really just destroy the availability of insurance and access to services for many individuals.” From the March 10 edition of MSNBC Live:

PAMELA CIPRIANO: Ali, we're really concerned. When we think about some of the changes that are proposed in this new law is that the tax subsidies, which are helping millions of individuals be able to afford health insurance, would change dramatically. Not only would they be reduced, but that they'd be altered in terms of how they will be available to individuals. One of the other big concerns we have, as you're hearing from many fronts too, is the consistent opposition to continuing the Medicaid expansion.So whether it winds down in 2019 or, as the president is alluding, he’d willing to negotiate an earlier end to Medicaid expansion, we know there will be millions of Americans who will lose that coverage. And these are some individuals who are least able to pay for any kind of coverage on their own. We were so pleased when the Affordable Care Act allowed states to make that expansion and federal dollars certainly have expanded that. But in this new set of legislation, that will really just destroy the availability of insurance and access to services for many individuals. [MSNBC, MSNBC Live, 3/10/17]

Former HHS Secretary Kathleen Sebelius: The GOP Bill Shifts “Subsidies Away From Lower Income People … To Really Wealthier And Healthier Folks.” During an interview with CNN’s Kate Bolduan, former HHS Secretary Kathleen Sebelius emphasized that the GOP health bill shifts “subsidies away from lower income people, folks who have higher cost insurance, to really wealthier and healthier folks” while simultaneously “allowing insurance companies to charge older Americans five times the rate of a younger American.” She criticized the proposed changes to Medicaid, saying it “may be the most important health safety net under disabled people, older Americans in nursing homes, [and] moms and kids in every state.” Sebelius explained that the GOP plan would cause “millions and millions of Americans” to lose coverage. From the March 10 edition of MSNBC Live:

KATHLEEN SEBELIUS: Well, I think it's important for the public to understand as this very fast process moves ahead, that there are really two battles that the Republicans are targeting. One is, as they talk about replacement and repeal of some framework around Obamacare, shifting subsidies away from lower income people, folks who have higher cost insurance, to really wealthier and healthier folks, but certainly less for older Americans and allowing insurance companies to charge older Americans five times the rate of a younger American. But in addition to the Medicaid expansion, which you just mentioned -- which now about 14 million people have taken advantage of in 31 states across this country -- there is actually a fundamental shift in the underlying Medicaid program, which has been in place for 50 years, and may be the most important health safety net under disabled people, older Americans in nursing homes, moms and kids in every state in the country; governors rely on this federal partnership. And capping that program and, over time, dramatically reducing the federal share of that program is going to impact state budgets well beyond those states that have expanded Medicaid.

[...]

KATE BOLDUAN (HOST): I do recall, as this is now playing out, I remember very distinctly when Obamacare was passed, the Affordable Care Act was passed, that the administration was very resistant to the moniker "Obamacare" until the administration decided to embrace it. What do you think this version should be called?

SEBELIUS: Well, I frankly hope this version isn't called anything. I hope by the end of the day we have a different kind of bill, because I think this bill, if it were to pass all the way through the House and the Senate, would make sure that millions and millions of Americans who desperately rely on financial security and health care lose their coverage, and that we shift back to a point where Americans no longer can take care of their families and know where they're going to get their health care. So I don't know what -- at the end of the day, I would love to see an opportunity to get a CBO score, to look at who gets insurance, who gets helped, have subsidies that actually look at people's income in addition to the cost of insurance, and where the needs are, and then make sure that we stabilize this. Do additional people need some help paying their premiums? You bet. And that would be a great idea. But taking that coverage away from some to give it to others, I'm not sure is the best way to go. [MSNBC, MSNBC Live, 3/10/17]

ACP President Dr. Nitin Damle: “The First Principle In Medicine Is That We Do No Harm,” And The GOP Bill Does “A Significant Amount Of Harm.” During an interview with MSNBC’s Kate Snow, Dr. Nitin Damle, president of the American College of Physicians, outlined “serious concerns” about the GOP health bill, noting that “the ACA provided insurance to 20 million people and they're at risk right now for being uninsured for 10 million people going forward.” He emphasized that many individuals who will lose their insurance are “in the Medicaid program. And those are the people who are the most vulnerable. They’re the older patients, they’re the sicker patients, they’re the poorer patients and we see them on a daily basis in our office.” He outlined the dangers of the GOP bill creating a “lack of access to care” and noted that “if patients with diabetes, patients with heart disease just aren’t able to seek, get access to care and take their medications, they are going to end up sicker … [and] they could end up dying.” Damle underscored that as a result of the AHCA, health care is “going to become unaffordable for the most vulnerable of our population.” From the March 10 interview:

KATE SNOW (HOST): What do you see every day and what are you most concerned about with this new piece of legislation?

NITIN DAMLE: First of all, thanks, Kate, for having me. The first principle in medicine is that we do no harm. And what we see this latest bill coming out of the House doing is a significant amount of harm. We have serious concerns around it. The ACA provided insurance to 20 million people and they're at risk right now for being uninsured for 10 million people going forward. And most of those are going to be in the Medicaid program. And those are the people who are the most vulnerable. They’re the older patients, they’re the sicker patients, they’re the poorer patients and we see them on a daily basis in our office. And really what happens when they don't have insurance is that they don't seek care. They get sicker, they show up in emergency rooms sicker, they get more advanced disease and they can't afford many times the prescription medicines that are out there for them to help them with their multiple diseases.

SNOW: And why are you worried that they won't have insurance because we just had a Republican congressman on saying, don't worry, everybody’s gonna have insurance.

DAMLE: Well, the Medicaid expansion will not occur as a result of the passing of the House act. After 2020 there will be no added funding for Medicaid. States will have to put up a lot of the money in order to keep their Medicaid programs going and states simply don't have the money to fund those programs. So we're going to see a significant reduction in access to care for our patients and the cost of care and the quality of care will suffer as a result.

[...]

SNOW: Mitch Jacques is a doctor at a clinic in rural West Virginia. He was on a New York Times podcast this morning. And he said for many of his patients, as many as 20 percent to 30 percent will lose their insurance. And he said -- quote -- “I think without question if the Republican policy goes through and health care is withdrawn from 20 to 25 percent of our patients, a number of those will die for lack of appropriate health care.” Is that hyperbole, Dr. Damle?

DAMLE: I mean, I don't think it's necessarily hyperbole as much as it is sort of an end result of the lack of access to care. So if patients with diabetes, patients with heart disease just aren’t able to seek, get access to care and take their medications, they are going to end up sicker and they're going to eventually develop congestive heart failure, diabetic complications, lose their sight, lose a limb or eventually have a heart attack or a stroke. As a result, they could end up dying. I'm not sure that there's a direct correlation there, but certainly it’s a concern. And I think this is why we're so concerned about this because it's going to become unaffordable for the most vulnerable of our population. [MSNBC, MSNBC Live, 3/10/17]

Experts Cite Issues With Defunding Planned Parenthood And Cutting Women’s Health Care Services During Cable News Interviews

ACOG CEO Dr. Hal Lawrence: If You Take Away The ACA’s Maternity Care Guarantee, “The Risk For Pregnancies Will Go Up. We’ll See People Without Care.” Dr. Hal Lawrence, the executive vice president and CEO of the American College of Obstetricians and Gynecologists, denounced the GOP’s plan to drop maternity care from the ACA’s essential health benefits package, declaring that “if you take that away, the risk for pregnancies will go up. We'll see people without care. We'll see higher instance of preterm births.” He highlighted the positive impact of the Medicaid expansion, noting that “we were able to get women into Medicaid, low-income women, before they became pregnant and help them be healthier and more prepared when they became pregnant.” He criticized the GOP’s plan to defund Planned Parenthood because “there are no other health care clinics to really pick up these 2.5 million visits that Planned Parenthood is providing.” From the March 10 edition of MSNBC Live:

KATE SNOW (HOST): We played some sound from yesterday’s debate in the House Energy and Commerce Committee. I’m not going to play it again, but it was an exchange where a Democrat asked a Republican congressman what the flaws were or what the mandates were in Obamacare. And he said, well for one, what about men having to purchase prenatal care. With I guess, the point being, men shouldn't have the same plan as woman and shouldn't have to pay for -- I don't know. It got a lot of attention. And I wonder what your take on all that is.

HAL LAWRENCE: Our take is, number one, we want to make sure that women have maternity care coverage. That's been a hallmark of the ACA and very, very important. If you take that away, the risk for pregnancies will go up. We'll see people without care. We'll see higher instance of preterm births. We know that with the expansion of Medicaid, we were able to get women into Medicaid, low-income women, before they became pregnant and help them be healthier and more prepared when they became pregnant. We were able to provide contraceptive services so they could have appropriate pregnancy spacing and so that they could become continually active in society, doing their jobs, taking care of their families. Taking care of women, providing good, ongoing women's health care is cost effective and good for the country.

SNOW: But what about this argument that the congressman just made, and many Republicans are making -- Paul Ryan has made it -- that people should have a choice over their own health care. They should be able to sort of pick and choose what coverage they want and not be mandated to have a certain thing. That's essentially the argument the Republican Congressman Flores was making was that it's OK -- if you don't think you're going to get pregnant, you don't have to have GYN coverage.

LAWRENCE: Well Kate, we know 50 percent of all pregnancies in this country are unintended. So, half the time women weren't planning to get pregnant. So if they weren't planning, they wouldn’t be covered. It’s like we have automobile insurance. We don't know we're going to have an accident. But we all know we’re gonna get sick, we all know we may well be injured, women may well know they'll get pregnant, men know they may well get prostate cancer. And so it's important you cover all of this. And the broader you have that denominator -- that's how actuaries evaluate insurance -- the less expensive it is for everybody.

[...]

SNOW: Dr. Lawrence, one last thing, congressional Republicans included a provision, as you know, to strip funding from clinics like Planned Parenthood. What is your biggest concern? I know you're concerned about that, but why?

LAWRENCE: We know the services that Planned Parenthood provide for ongoing women's health care. Through contraceptive services, they help prevent over 500,000 unintended pregnancies. They provide over 270,000 pap smears, 360,000 breast cancer screenings. So they really assist. And there are no other health care clinics to really pick up these 2.5 million visits that Planned Parenthood is providing. They help to provide ongoing women's health care. We have such good coverage through the ACA for women's care. What we really don't want to do is see the clock turned back on women's health. It is important that women have access to contraception, ongoing preventive care services and the question Dr. Damle just answered, you know, there is data on breast cancer. Uninsured women have a higher mortality rate from breast cancer than insured women. [MSNBC, MSNBC Live, 3/10/17]

President Of Planned Parenthood Cecile Richards: Defunding Means “Millions Of Folks Who Count On Us Now For Preventative Health Care, Birth Control, Cancer Screenings … Would No Longer Be Able To Come To Planned Parenthood.” Cecile Richards, president of Planned Parenthood, explained to CNN’s Anderson Cooper that “millions of folks who count on us now for preventative health care -- birth control, cancer screenings at Planned Parenthood -- would no longer be able be come to Planned Parenthood” as a result of the GOP health care bill. Richards emphasized that by defunding the organization over abortion concerns, the GOP “would be blocking women from getting ... the very services that help prevent unintended pregnancy in the first place.” Richards underscored the successes of Planned Parenthood, noting that “we’re at an all-time low for teenage pregnancy … because more women are getting access to family planning and good birth control” at Planned Parenthood centers. From the March 8 edition of CNN’s Anderson Cooper 360:

ANDERSON COOPER (HOST): I'm wondering, under the proposed Republican replacement for the Affordable Care Act, Planned Parenthood figures prominently. What would it mean for Planned Parenthood if the bill passed as it is right now? Obviously, there may be changes.

CECILE RICHARDS: Well, it's really important, Anderson. I know that Paul Ryan, Speaker Paul Ryan, has said that we're being defunded. But the truth is, we're not in the federal budget. We don't have a line item in this budget. What he's actually doing and what he’s saying in this legislation is that the millions of folks who count on us now for preventative health care -- birth control, cancer screenings at Planned Parenthood -- would no longer be able be come to Planned Parenthood, and we wouldn't be reimbursed for that care. It's also really important to understand from this legislation, remind folks that actually abortion services are not paid for by the federal government. So actually, what they would be blocking women from getting from Planned Parenthood is the very services that help prevent unintended pregnancy in the first place. And that's birth control, which is our specialty.

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RICHARDS: But it's important to understand that we see 2.5 million patients in this country every year. One in five women in the country have been to us for health care. We're here to serve women, provide them all the health care they need; that includes birth control and cancer screenings and safe and legal abortion access. And we would never trade away the rights of women or the rights of women to access full reproductive health care for this kind of proposed deal.

COOPER: Have you gotten any assurances from moderate Republicans who might be opposed to Planned Parenthood's funding being tied to this bill. Have they told you they would try to oppose it in its current form?

RICHARDS: Absolutely. I mean, moderate Republicans all across the country, and even traditional conservative Republicans, who believe that the government shouldn't be in the business of telling people where they can and can't go to for health care, are in opposition to this bill. And that includes millions of our own patients. We see millions of people across the country, including many of the states where President Trump has supporters. Half of President Trump's own supporters oppose defunding of Planned Parenthood. And this is what I think Congress is missing. Is that this is -- women's access to health care is not a partisan issue. Women need it from all walks of life. And the real irony, Anderson, is that we are now -- because of the good work of Planned Parenthood and a lot of others -- we're at an all-time low for teenage pregnancy in this country. We're at a 30-year low for unintended pregnancy in America. It's because more women are getting access to family planning and good birth control, including Planned Parenthood health centers, and we need to double down on that progress, and not roll back the opportunities for women in America. [CNN, Anderson Cooper 360, 3/8/17]

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