A bipartisan bill making changes to the Affordable Care Act is Congress’ current path forward, said House Minority Leader Nancy Pelosi during a visit Tuesday to University Medical Center.
Pelosi visited the hospital days after President Donald Trump ended a key component of the Affordable Care Act that helped insurance providers cover costs. A new bipartisan compromise for the ACA is being proposed by Sens. Lamar Alexander, R-Tenn., and Patty Murray, D-Wash.
UMC, which took on more than 100 patients the night of the Oct. 1 shooting on the Las Vegas Strip, had run tens of millions of dollars in the red before the Affordable Care Act passed and helped bring the facility into the black.
Pelosi thanked those involved in the hospital’s response the night of the shooting and afterward. The California Democrat called Rep. Ruben Kihuen, D-Nev., hours after the shooting.
“Everybody recognizes the role that you all played and your associates of other institutions as well, so thank you for that,” Pelosi said during a roundtable with hospital officials. “It’s with great humility that I come and hear what you have to say.”
UMC Trauma Director John Fildes told Pelosi that a few victims died on their way to the hospital, but no others were lost.
“Anyone who arrived alive survived,” Fildes said.
Pelosi said protecting the Affordable Care Act, funding the Children’s Health Insurance Program (CHIP), and providing protection from deportation for young immigrants have all been fights for Democrats this year. Pelosi noted that Trump is pushing $2 trillion in tax cuts for the wealthy without offsetting the loss in the budget. Meanwhile, Republicans want $30 billion in CHIP funds offset before they’ll approve it, she said.
She said the Alexander-Murray proposal is good, although she hasn’t seen all the details yet.
“Alexander-Murray is a good step forward,” Pelosi said. “That’s really the path we’re on.”
The proposal sets out two years of cost-sharing reduction payments, funding for outreach, and includes waivers, which Republicans wanted to be more accessible to states. Pelosi said the waivers under Alexander-Murray are intended to not disadvantage the poor, severely disabled or those with preexisting conditions.
“So it kind of limits what the waiver will do,” she said. “Those were some of the sticking points that had to be debated.”
Pelosi said House Speaker Paul Ryan told her that Republicans felt burned after the repeal failures in the Senate.
“We had confidence even though it was a Senate procedure,” she said of Alexander-Murray. “We had asked the House, we had asked the speaker — can we engage in a similar process? He said our people are still smarting from the defeat in the Senate. So they still are, I guess. Maybe that means we’ll just accept what they send us.”
Many at the roundtable touched on the importance of the Affordable Care Act, especially in areas such as mental health, where patients who may have never had access to treatment could get help through their coverage.
Kihuen noted that the state’s uninsured rate is just about half of what it was before the passage of the ACA and Gov. Brian Sandoval expanded Medicaid under the Obamacare law. Pelosi noted the importance of Sandoval’s support for the Medicaid expansion and opposition to the failed Graham-Cassidy repeal plan, which Sen. Dean Heller, R-Nev., was part of.
Clark County Commissioner Lawrence Weekly, who was born at UMC, said the hospital has had financial issues and had to do more with less.
“(Trump) stopping by here for a moment, and it’s our hope that Number 45 gets it,” he said. “That we are open for business, that we do save lives.”
Commissioner Chris Giunchigliani said Las Vegas is a unique community, and people don’t realize how small it still is. She said it’s absolutely immoral if funding is not provided for the Children’s Health Insurance Program, which Congress has yet to do.
“We have access to some of the most dynamic people in the world in this hospital, and it’s an unsung story and unfortunately had a massacre to help tell our story, that we need to invest more money, that ACA has worked and helped us,” Giunchigliani said.
Tuesday’s roundtable also included UMC CEO Mason VanHouweling, Children’s Hospital Medical Director Meena Vohra, Chief of Medical Staff Dale Carrison, Chief Nursing Officer Debra Fox, Governing Board members Eileen Raney and Robyn Caspersen, UMC Trauma Center Clinical Supervisor Antoinette Mullan, Air Force Colonel and surgeon Brandon Snook, UMC Assistant Chief Nursing Officer of Professional Practice Beth Hock, UMC Associate Administrator Vick Gill, Chief Administrative Officer Marcia Turner, and Elizabeth Bolhouse, a UMC nurse and SEIU Chief Steward for Nursing.
What Trump’s ACA changes mean for Nevada
Trump also issued orders to allow employers to deny coverage for contraceptives for religious reasons, and expand access to association health plans that offer insurance to members and can, in some cases, skirt key regulations in the ACA.
Heather Korbulic, executive director of the Silver State Health Insurance Exchange, said carriers were allowed to plan for a loss of cost-sharing reduction payments, so most consumers who receive subsidies will not be impacted. Others who do not qualify for subsidies may see rates go up.
She said the executive order on contraception, allowing employers to claim religious exemptions for that coverage, will not impact Nevada. Korbulic said the state enshrined that portion of the ACA into state law this session, requiring carriers to cover 12-month supplies of contraceptives.
Korbulic also said that the exemption for associations will procedurally take longer to implement, but once in place, it could end up pushing healthier people out of the exchange and onto association health plans. She said this drives up costs for the sicker individuals who are left in the marketplace.
Open enrollment is shortened to 45 days this year, and runs until Dec. 15. Korbulic said residents who may want to purchase insurance on the state’s exchange should go to nevadahealthlink.com to find a free, licensed enrollment professional to meet with.