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Editor's note: Because of the dynamic nature of the Senate work on the Better Care Reconciliation Act, this online version of this article has been updated from the print version. This online version reflects activity that happened in the Senate after Catholic Health World went to press.

By JULIE MINDA

NEW ORLEANS— A little over a week after more than 1,000 ministry leaders and associates gathered here June 11-13 for the Catholic Health Assembly, Senate Republicans released a health reform proposal that CHA President and Chief Executive Officer Sr. Carol Keehan, DC, maintains will have a "devastating impact on our nation's most vulnerable populations."

The Senate Better Care Reconciliation draft legislation made public June 22 is very similar to the House-passed American Health Care Act. Sr. Carol said in a statement, "The small tweaks made in the newly released Senate bill do not change the fact that millions will lose their health care especially through a complete restructuring and deep federal funding reduction to the Medicaid program. We can and must do better on behalf of all those who rely on our nation's health care programs and providers."

She called for a new bipartisan focus to make improvements in the U.S. health care system — improvements intended to stabilize the insurance market, make care more affordable and expand health coverage. "We ask Congress to ensure that funds currently supporting health care programs remain in the system under any legislative proposal, instead of being diverted for tax cuts for the more fortunate."

After the July 1 issue of Catholic Health World went to press, the nonpartisan Congressional Budget Office projected the Senate bill would increase the number of uninsured by 22 million by 2026. In a follow-on report, the budget office said under the Better Care Reconciliation bill federal Medicaid spending would fall by 26 percent by 2026. Unable to muster the votes needed to pass the legislation, its chief author Senate Majority Leader Mitch McConnell delayed the vote, hoping to use the July 4 recess to make changes that could secure the yes votes of at least 50 Republican senators. No Democrats are expected to support the bill, and McConnell said that if Republicans lack the votes to pass it, he would have to work with Democrats on health care policy changes.  

CHA continues to call on its members to contact their senators and be a voice for the vulnerable. "Above all, we urge our elected officials always to keep in mind the unborn and the many millions of poor individuals and vulnerable families who will be affected by any changes to our health care system," Sr. Carol wrote in her statement.

At the Catholic Health Assembly, Sr. Carol spoke in a "Washington Update" general session with Louisiana Gov. John Bel Edwards about the benefits of the Affordable Care Act, which was the target of Congressional Republicans' repeal and replace fervor.

Health care access is a priority for Edwards, and the Democratic governor signed an executive order expanding Medicaid in Louisiana on Jan. 12, 2016, his second day in office. He said he was particularly proud that Louisiana had expanded Medicaid during Pope Francis' Year of Mercy.

Edwards spoke of the lifesaving impact of that decision. He said Louisiana was on track to save over $200 million in the fiscal year ended June 30 and would save over $300 million next year because of federal contributions to health care under the Affordable Care Act. The ACA has led to more jobs in his state's health care sector, he said.

The governor's praise for the ACA echoed sentiments expressed by Sr. Carol, by CHA Chairperson Dr. Rod Hochman, and by other presenters and attendees at the assembly.

The annual meeting came during a critical time in Republican efforts to repeal and replace the ACA. House Republicans approved a replacement bill in May; and, in mid-June as ministry leaders gathered in New Orleans, the Senate Republicans' health care work group was meeting in closed session to draft their version of ACA replacement legislation. Sr. Carol and Edwards both called on Senate Republicans to slow down and take time to craft a replacement bill that protects the vulnerable and improves upon the ACA.

Advocacy by CHA members was instrumental in the passage of the ACA; and, before Edwards took the stage, Hochman had used his opening remarks as CHA chair to say, "We have to be the voice for the voiceless. We have to stand for 23 million people who are covered by the ACA and are in danger of losing coverage."

Hochman said that most of the public is unaware that, in the next few years, almost one in two children in the U.S. will be born to mothers insured by Medicaid. According to the Kaiser Family Foundation, Medicaid pays for the care of six in 10 nursing home patients. In a June 27 interview with Catholic Health World, Hochman said, the potential "evisceration" of Medicaid is cause for great concern. "There is nothing in this bill that makes any sense to any of us in health care leadership. We think it's a tax cut bill, and not a health care bill," Hochman said.

Sr. Carol told the assembly audience proposed deep cuts to federal Medicaid funding would, when combined with structural changes sought by ACA opponents, severely limit Medicaid's ability to cover the poor, the vulnerable and the elderly for years to come.

She said that key protections established by the ACA, including those that set out essential benefits for insurance policies, a ban on lifetime caps for insurance claims and prohibitions against denying coverage for people with pre-existing conditions could be eliminated in legislation being hurried through Congress without public hearings.

Sr. Carol said CHA members have been at the forefront of advocacy efforts opposing harmful changes to the ACA. She said that so far this year, through the CHA website alone, CHA members had generated nearly 5,000 messages to their congressional delegates. "We need to keep the pressure on," she said during the June 12 general session. She urged attendees to get the word out to employees, volunteers, board members and community groups. "I know there can be advocacy fatigue, but this is no time for fatigue," she said.

Louisiana stands to lose more than $5 billion in 10 years in federal Medicaid dollars under proposals currently under consideration in Congress. About 500,000 people in the state would lose health care coverage if they currently have it through the federal marketplace or through Medicaid expansion. And by 2025 or 2026, all of the benefits of insurance expansion under the ACA will be gone. "Once someone rotates off of coverage they will never get it back," Edwards told the audience.

Edwards said there is not a state that expanded Medicaid under the ACA that wants to reverse those gains.

On a personal note, Edwards said one of his daughters has spina bifida, and he fears she would not have access to private insurance if legislators drop guaranteed issue protection for those with pre-existing conditions.

Edwards said his mother taught him what social justice looked like in action. She graduated from Baton Rouge's Our Lady of the Lake School of Nursing 60 years ago. "And after having eight kids in 10 years — all of us born at Our Lady of the Lake — she went to work at New Orleans' now defunct Charity Hospital in the emergency room. She did that for 30 years and she took care of the poorest people in our community. That is also where her family got care because she said if it was good enough for her to draw a paycheck, it was good enough for her family to get care. It was her example that taught me so much about health care and taking care of the least among us."