Ceci Connolly: Concerns about new ACA repeal and replacement bill include money, Medicaid

NASHVILLE, Tenn.—While Ceci Connolly sees some positives in House Republicans’ recently introduced healthcare bill, she and the members of the Alliance of Community Health Plans are skeptical about the practical implications of the legislation.

Connolly, the alliance's president and CEO, is encouraged, for instance, that some of the major policy changes included in the bill won’t be effective until 2020, which gives health plans and their customers more time to adjust, she said in an interview following her keynote address at the 2017 Rise Summit.

However, “we’re still very concerned that there’s just not enough money in there to cover and care for 20 million people,” she said. “A $2,000 tax credit, what is that going to buy you?”

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Further, while it is good that cost-sharing subsidies will stay in place through 2019, it’s still potentially problematic that they will then disappear. If that money is pulled from the individual market, she said, “again, I don’t think that the math is really going to work.”

While the Congressional Budget Office has yet to release a scoring of the bill, Connolly pointed out that it's "an open question" how much value the Trump administration places in the CBO. The value of scoring, though, she said is to measure practical concerns such as "how many people lose coverage, how many people can’t afford it, how many people are going to be confused navigating a new system that’s going to involve a tax credit and an [health savings account] and all of those elements."

It’s important to remember, though, that the House’s bill is only an “opening salvo” in what will likely be a long legislative fight over the future of the ACA, Connolly pointed out during her keynote speech.

Concerns about Medicaid, health outcomes

Perhaps one of the more contentious aspects of the GOP’s bill is what it would have in store for Medicaid.

Indeed, while Connolly said it’s “a big if” whether the program actually moves to per capita cap funding structure, she said she’s worried about the potential coverage and care limitations such a shift could bring for such vulnerable populations.

Not only do Medicaid beneficiaries tend to have multiple chronic conditions as well as behavioral and substance abuse challenges, but their socioeconomic status also can be so precarious “that even something as simple as going for a checkup can be a major undertaking,” she noted.

In fact, if states respond to the reduced federal funding by curtailing new Medicaid enrollment in 2020, data from The Commonwealth Fund indicate that “millions of people with Medicaid will lose their coverage,” according to a new post from the organization.

Still, the CEOs of ACHP health plans, whom Connolly notes have considerable experience in managed Medicaid, have told her they don’t necessarily object to the concept of a per capita cap. They do, however, think it can’t be a one-size-fits-all policy, she noted.

“What they’re suggesting is that the policy needs to be tailored to different sub-populations,” she said, because different types of Medicaid beneficiaries, such as children and mental health patients, have very different needs.

“Understanding the complexity of the group and having a policy that is going to tailor resources appropriately is the only way it’ll work,” Connolly said.

The leaders of ACHP health plans—which tend to be very patient-centered and have strong ties to providers--have also told Connolly that they’re worried the discussion taking place on Capitol Hill is focused solely on insurance and fiscal concerns.

“No one is articulating how or why this matters to the health of our people and communities, and that worries us,” she said, adding, “it appears to be a federal budget exercise.”