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Alabama physician groups worried by proposed health care law changes

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HUNTSVILLE, Ala. -  As the U.S. Senate debates its version of an overhaul of the American health care system, physicians in Alabama are warning that steep cuts in Medicaid funding would hurt state residents.

The Senate bill, which estimates suggest would cut a billion dollars from health care spending over 10 years, stalled last week and Majority Leader Mitch McConnell said the work would resume after the July 4 holiday recess. The Senate calendar has members returning to Washington July 10.

The lawmaking process is being closely watched in Alabama, judging by a statement issued by members of the Medical Association of the State of Alabama, the Alabama Chapter of the American Academy of Pediatrics and the Alabama Academy of Family Physicians.

In a joint statement, the medical groups said they are not just speaking for doctors, but also “thousands of low-income Alabamians served by them,” and they are concerned the Senate bill “fundamentally changes how Medicaid is funded ...”

The concerns echo the country's largest physician's group, the American Medical Association, which said it opposes the Senate bill and cited concerns about access to health care and cuts to Medicaid spending.

Republicans have called for a repeal of the Affordable Care Act – Obamacare – and have been working on a compromise that will persuade all 52 Republican senators to support the measure. The Senate bill’s provisions include a health care tax cut for corporations, significant reductions in Medicaid spending and tax credits to offset the cost of health care.  It would also give states the right to seek a waiver that would let insurers choose what conditions and illnesses they would cover.

Criticism of the bill grew after the Congressional Budget Office in late June released its analysis of the measure. The CBO found, in part, “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.”

The CBO analysis says under the bill Medicaid spending would be reduced by 26 percent by 2026, about $772 billion.

Dr. Nola Ernest, an Enterprise pediatrician and member of the American Academy of Pediatrics, said reductions in Medicaid spending would harm Alabama’s health care system and she hopes changes to the bill can be made before it is passed to blunt that impact.

Alabama currently has 480,000 children on Medicaid, representing more than 40 percent of the state’s kids, Ernest says. She said the state’s doctors and hospitals are doing a good job providing care, despite cost pressures. She said Medicaid focuses on preventative care, which has been shown to reduce health care costs.

“We spend about $2,200 a year per child enrollee, which is less than most states in the country, and less than half of what we have to spend for adult enrollees in the state,” she said. “But these changes to what is already a bare-bones program will mean that kids will lose essential health benefits such as preventive health services. Some of them will be left without insurance altogether.”

Ernest said cuts could mean some doctor’s offices and even rural hospitals could close if Medicaid payments are reduced.

She said changes are needed, pointing out that even though the Affordable Care Act made health insurance available to more Americans, health care costs continued to rise, causing many families in Alabama to seek government assistance for health care.

“Actually more and more families are starting to choose public insurance options, even working families, because they cannot get dependent, affordable, dependent care coverage through their employer,” she said. “And so, this includes Medicaid, but also includes the state CHIP Program which we call All Kids here in Alabama.”

Ernest said she hopes Alabama’s U.S. Senators Richard Shelby and Luther Strange will vote “no” on the bill as it currently stands. But if that is not likely, she called on them to seek input from state doctors on what kind of changes the system needs.

“The hope going forward is that we will be able to sit down at the table and talk about things that actually will impact health care costs,” she said. “Things like prescription drug prices, or increasing the utilization of highly cost-effective service and decreasing the utilization of services like the emergency rooms that cost us all.”