On behalf of the 48 member hospitals in the North Dakota Hospital Association and the 1,600 physicians and medical students in the North Dakota Medical Association, we are writing to express our concerns about the Senate’s health care bill, the Better Care Reconciliation Act.

NDHA and NDMA have long advocated for high quality, affordable health coverage for all North Dakotans. We know that without health insurance many people put off seeking medical treatment until their conditions are so severe they require care in a hospital's emergency department — the most expensive venue for that care.

Thousands of North Dakotans have obtained coverage through Medicaid Expansion and the health insurance exchange. We believe that as a result of this coverage expansion, North Dakota's residents will be healthier and more productive in the long run. In considering any changes to the current system, coverage is our top priority. The BCRA raises serious policy concerns in that regard. It is estimated that 22 million people will lose their insurance coverage by 2026, 15 million fewer people would have insurance in 2018 than today, and 49 million people would be uninsured by 2026.

We are especially concerned about the bill's Medicaid provisions, which would  reduce vital federal support for this program. It would shift additional Medicaid costs onto the state, reducing federal Medicaid spending by $772 billion, or 26 percent, over 10 years. Had this system been in effect during the last session, our state Legislature would have had to appropriate $315 million in general funds rather than $45 million.

This is simply not sustainable.

The Senate bill would also lower the threshold for subsidies that help individuals with low income afford health coverage and lower the subsidies themselves. States could seek waivers from insurance regulations so that policies would no longer have to cover things such as maternity care, emergency services and mental health treatment. And the BCRA would repeal or delay the taxes — mainly on the wealthy — that offset the cost of the coverage expansion. It is fair to say that the price for these tax cuts for higher income Americans is deep Medicaid spending cuts for lower-income, disabled and elderly Americans.

NDHA and NDMA support maintaining key insurance market reforms, such as prohibiting pre-existing condition exclusions, maintaining adjusted community rating, and providing parental coverage for young adults up to age 26. In addition, Congress must make sure that Medicaid, CHIP and other safety net programs are adequately funded.

However, in our view, the BCRA does not achieve these goals. We urge our senators to vote against the BCRA. Instead, the Senate should go back to the drawing board and seek bipartisan solutions that truly reform health care. We stand ready to assist in achieving a better system.

This column was signed by Jerry Jurena, president of the North Dakota Hospital Association; Dr. Craig Lambrecht, NDHA board chairman; Courtney Koebele, North Dakota Medical Association executive director; and Dr. Debra Geier, NDMA president.

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