Democratic U.S. Sen. Amy Klobuchar was in Northfield Saturday, listening to concerns about the Better Care Reconciliation Act, a plan Senate Republicans hope replaces the Affordable Care Act, commonly known as Obamacare.
It's expected that the Senate will vote on the bill, unveiled Thursday, within a week.
Klobuchar met with Northfield Hospital & Clinics staff and board members for about 45 minutes looking for their views on the proposed legislation along with issues the hospital faces.
“I’m very concerned about the impact on hospitals,” Klobuchar said. “I’m all for making changes to the ACA.”
The Senate Republican version is similar to the one the House of Representatives proposed earlier this year, but differs in some areas. The House version proposed tax credits to pay premiums based on age that max out at $4,000. The oldest people under 65 can be charged five times more than the youngest. In the Senate version, the oldest people under 65 would pay five times more than the younger people and there would be subsidies for people with incomes up to 350 percent of the poverty level.
For low-income nursing home residents in both the Senate and House versions, skilled nursing would be covered up to 100 days by Medicare. Medicaid services could be cut as federal funding declines in the House version. In the Senate version, Medicaid coverage for long-term care could be cut as federal funding decreases.
Under the Senate version, insurance companies will have to accept all applicants with pre-existing conditions but the bill lets states ask permission to reduce essential health benefits.
In regard to mental health services the Senate bill, Medicaid would not be required to cover mental health after 2019.
Both the House and Senate versions call for a phase out of federal funding for Medicaid expansion. The Senate version calls for the phasing out to begin between 2021 and 2023, more reductions would start in 2025.
Northfield Hospitals & Clinics CEO Steve Underdahl fears that the proposed changes will have a damaging effect on patients' finances.
“We still find ourselves in the unenviable position that we contribute to peoples’ bankruptcies,” he said. “Since the ACA, the bankruptcy rate has gone down but I’m fearful that this will charge that up again.”
He also foresees more consolidation in the insurance industry. Several large insurance companies have already begun merger plans.
“No matter how this works, one of the unintended consequences is the very large will take over when we’re done,” Underdahl said. “We’re going to have four, big, mega insurance companies. Towns of 20,000 people will be on the short end of that stick. I think we’re already seeing some of that consolidating.”
Dr. Jennifer Fischer, who works in emergency medicine, raised concerns about the lack of personal responsibility and education in any version of any healthcare bill. She said the hospital has seen a rise in emergency visits.
Fischer also pointed to an increased difficulty with ordering tests for patients.
“More and more we’re going to protocols,” Fischer said. “If I’m going to order something, I really need to justify it. If I miss something because I couldn’t order a certain test, I’m still liable.”
Toward the end of the meeting Laura Peterson, in-house legal counsel and compliance officer with Northfield Hospital & Clinics tried to sum up the healthcare situation.
“I’m truly speaking personally here, not as an employee of the hospital, this is a disaster,” Peterson said. “Why are we spending $10,000 a person a year when other countries are spending $4,000 a year and their care is as good as ours?”
Klobuchar responded by saying there are options available.
“Right now we’re trying to improve what we have with knowing that there are other options that will become available when people start looking at this and how much it costs,” Klobuchar said. “There are ways you can do it with expanding Medicare gradually or Medicaid. Right now we’re just trying to stop something that makes it worse.”