In my effort to stay current this week on the ever-moving Senate healthcare bill reform effort – the Better Care Reconciliation Act (BRCA) – I’ve been tracking the opinions coming from the major U.S. healthcare associations, notably the hospital and medical groups.

Just shortly before and after the much-anticipated analysis from the nonpartisan Congressional Budget Office (CBO) on Monday, letters to the Senate, press releases and other statements began pouring in regarding the BRCA.

CBO analysis on Monday found that:

• The Senate bill would increase the number of people who are uninsured by 22 million in 2026 relative to the number under current law, slightly fewer than the increase in the number of uninsured estimated for the House-passed legislation.
• By 2026, an estimated 49 million people would be uninsured, compared with 28 million who would lack insurance that year under current law.
• CBO and the Joint Committee on Taxation (JCT) estimate that, over the 2017-2026 period, enacting this legislation would reduce direct spending by $1,022 billion and reduce revenues by $701 billion, for a net reduction of $321 billion in the deficit over that period

The full CBO analysis can be found here.

As of today, here’s a roundup of where the various groups stand. Our intent is not to take a political position in this article, but rather to provide a roundup of hospital and medical association’s stance on the BRCA at this time.

Hospital Associations’ Positions on BCRA, Senate Healthcare Bill

American Hospital Association

In a public statement issued by Rick Pollack, President and CEO of the American Hospital Association, he stated:

Unfortunately, the draft bill under discussion in the Senate moves in the opposite direction, particularly for our most vulnerable patients. The Senate proposal would likely trigger deep cuts to the Medicaid program that covers millions of Americans with chronic conditions such as cancer, along with the elderly and individuals with disabilities who need long-term services and support. Medicaid cuts of this magnitude are unsustainable and will increase costs to individuals with private insurance. We urge the Senate to go back to the drawing board and develop legislation that continues to provide coverage to all Americans who currently have it.

National Rural Health Association

Alan Morgan, CEO of the National Rural Health Association (NRHA), said, “Members of Congress seem to be working toward a solution that perhaps makes things even worse.” NRHA has acknowledged that while the goals of the ACA were laudable, the legislation has failed in part to provide for the needs of health care in rural America.

A statement issued by Erin Mahn Zumbrun, NRHA’s Government Affairs & Policy Manager further expanded on NRHA’s position of the Senate bill:

While the bill appears to have some changes from the House version, the bill maintains some of the provisions that led to NRHA’s opposition. NRHA is disappointed that the bill includes deep Medicaid cuts that change the program from an open-ended federal commitment to a capped federal payment that limits federal spending, leaving either states, patients, or providers to struggle with the loss of funds.

The Medicaid expansion is also eliminated, being phased out over a four-year period from 2020 to 2024. Tax credits to assist individuals in purchasing insurance remain but are substantially reduced, likely leading to many more individuals unable to afford health insurance. The bill also repeals billions of taxes included in the Affordable Care Act (ACA) to pay for the coverage expansion, as well as eliminating the individual and employer mandates.

Federation of American Hospitals

On the Federation of American Hospitals (FAH) blog on June 22, the association stated its position on the BCRA:

Most providers and clinicians, including FAH, are deeply concerned by the Better Care Reconciliation Act (BCRA) discussion draft released today.  The opportunity is still there for the Senate to make critical revisions to keep the promise of accessible, affordable health care coverage and ensure Medicaid remains a viable program because it is essential to our most vulnerable neighbors. FAH has been explicit about our health reform core principles: maintain coverage levels, reasonable Medicaid structural reforms, sustain affordable, high quality individual coverage, protect employer-sponsored insurance and roll back untenable cuts to hospital reimbursement.  At this time, the BCRA draft does not sufficiently meet those principles which are so important to those Americans our community hospitals serve and our employees who care for those patients every day. Now is the time for the Senate to hit reset and make key improvements to this legislation. 

America’s Essential Hospitals

A press release issued on June 22 by America’s Essential Hospitals on BRCA stated:

Senate leaders today have put ideology ahead of lives with a plan that puts health and home at risk for millions of working Americans and that would badly weaken essential services for everyone in communities across the country.

Today’s Senate bill makes few material improvements to the deeply damaging House legislation, and might be worse overall. For the hospitals that protect millions of Americans and their communities — our essential hospitals — this bill might even accelerate decisions by some to reduce services or close their doors.

This could leave many people without local sources of lifesaving services, such as trauma, burn, and neonatal intensive care.

America’s Essential Hospitals stands by two guiding principles: affordable health care coverage for all Americans and sufficient resources for essential hospitals to meet their vital community mission. The Senate plan violates both principles and will make our nation sicker, less productive, and less secure.

We oppose this plan and appeal to senators to consider the needs of all Americans and work with us and other stakeholders — in an open and transparent process — to fix what’s wrong with our health care system while preserving progress made toward coverage and stability for all.

Medical Associations’ Positions on BCRA, Senate Healthcare Bill

American Medical Association

In a letter issued by the AMA CEO James Madara to Senate Majority Leader Mitch McConnell on the BCRA on June 26, Madara wrote:

On behalf of the physician and medical student members of the American Medical Association (AMA), I am writing to express our opposition to the discussion draft of the “Better Care Reconciliation Act” released on June 22, 2017. Medicine has long operated under the precept of Primum non nocere, or “first, do no harm.” The draft legislation violates that standard on many levels. We believe that Congress should be working to increase the number of Americans with access to quality, affordable health insurance instead of pursuing policies that have the opposite effect.

The full letter can be read here.

American Congress of Obstetricians and Gynecologists, American Academy of Family Physicians, American Academy of Pediatrics, American College of Physicians, American Osteopathic Association and the American Psychiatric Association

In a joint press release on BRCA issued June 22 by the above six major medical groups stated:

The physician leaders of six organizations representing more than half a million of America’s frontline physicians are strongly opposed to the Better Care Reconciliation Act. The U.S. Senate’s proposed health reform bill contains provisions that would do great harm to patients by repealing and undermining essential coverage and key patient protections established by the Affordable Care Act and make health care unaffordable for millions of Americans.

Given the broad impact of this bill and the magnitude of the changes made, including to the Medicaid program, our organizations are deeply concerned with the hidden and hurried manner with which this bill was drafted. We are concerned that no public hearings were held and no physician or patient expertise was sought during the bill’s development.

Payer Perspectives on BRCA

A spokesperson for America’s Health Insurance Plans told The Hill in a recent article, “We are not taking a support or oppose position.”

The Blue Cross Blue Shield Association, which represents insurers covering more than 100 million Americans stated in the same article, “We are encouraged that the draft Senate legislation funds cost-sharing reductions.”