Health care experts in Maine lambasted the Senate version of the replacement for the Affordable Care Act that was unveiled Thursday after weeks of secret deliberations.

They said the bill would substantially cut Medicaid, drive up insurance premiums for older Mainers, put rural hospitals in a financial squeeze and reduce access to opioid treatment, among other deficiencies.

“All this week we’ve been hunting around here for the Republican health care bill. (Thursday) morning we found it, and I’m kind of sorry we did because it’s pretty bad,” Maine Sen. Angus King said in a Facebook video he posted Thursday afternoon.

King, an independent who caucuses with the Democrats, was referring to the closed-door deliberations on the bill by 13 Republican senators over the past several weeks. “It basically increases the cost of health care, particularly for seniors; massively cuts Medicaid, which supports people in nursing homes, disabled people, children. I mean, it is a really cruel bill,” he said.

A Senate vote could occur within a week, and if the bill passes Congress, it would fulfill a seven-year promise by Republicans to dismantle the Affordable Care Act, the signature domestic achievement of the Obama administration. The repeal would also cut taxes for the wealthy.

Health policy experts attacked the bill for scaling back Medicaid, which would result in millions losing insurance. While there’s not yet a Congressional Budget Office score for the Senate bill, the House bill to replace the ACA would leave 23 million fewer Americans with insurance, including 12 million fewer Medicaid recipients, by 2026.

On “Meet the Press Daily” on MSNBC on Thursday afternoon, Sen. Susan Collins, R-Maine, told host Chuck Todd: “I can’t support a bill that is going to result in tens of millions of people losing their health insurance.”

Since the ACA went into effect in 2013, the uninsured rate in the United States has dropped from about 17 percent in 2013 to 11 percent in 2016, according to Gallup polling. Maine’s uninsured rate in 2016 was 9.1 percent, according to Gallup.

The Senate bill not only ends the Medicaid expansion within seven years; it also changes the underlying formula for how the entire Medicaid program is funded.

The cuts to Medicaid under the Senate bill are harsher than the House bill that was approved in May, especially after 2025.

“It’s a train wreck,” said Steve Butterfield, policy director of Consumers for Affordable Health Care, an Augusta-based health advocacy group. “It’s a permanent overhaul of Medicaid as we know it.”

Emerging from a meeting with Senate colleagues Thursday, Sen. Susan Collins, R-Maine, responds to reporters’ questions on the health-care bill. Washington Post/Melina Mara

However, the Senate bill also addresses some issues that generated opposition to the House measure. For example, it would not give states the opportunity to opt out of protections for consumers with pre-existing medical conditions; and it offers subsidies based on income, like the ACA does, not based on age, as the House bill did.

The Medicaid cuts were among the chief complaints by Maine health care experts reacting to the bill’s release Thursday.

“We continue to be amazed and discouraged that this bill includes a major restructuring of Medicaid, which is tacked on and had nothing to do with the Affordable Care Act,” said Jeff Austin, vice president of government affairs for the Maine Hospital Association. “Rural hospitals would be absolutely devastated.”

Medicaid is a program for the low-income and disabled, funded with a blend of federal and state dollars, and the 265,000 people in Maine who have Medicaid consist of mostly the disabled, children and low-income seniors who qualify for both Medicaid and Medicare.

Liz Harmon, 31, of Brooksville, is a lobsterwoman who said her family avoided bankruptcy because they were able to qualify for Medicaid when her son, Orin, was born with heart defects. She said Orin’s medication costs thousands per month and he will need more surgeries, so Medicaid is keeping them from declaring bankruptcy.

Harmon said Medicaid is vital to many families like hers, and she would hate to see it cut.

“It’s discouraging to hear the news,” Harmon said of the Senate bill. “I wish I could force these people to walk a mile in my shoes.”

The new formula would be stingier in terms of how much federal money is sent to the states for Medicaid, and would require states to either pony up extra funds or cut services. States would be under pressure to cut optional Medicaid services, such as for adults with intellectual disabilities, low-income seniors or children with specialized health needs, said Robin Rudowitz, associate director of the program on Medicaid and the uninsured for the nonprofit Kaiser Family Foundation.

“None of these will be easy choices to make, but states will be forced to make them,” Rudowitz said.

The cost shifts from changing the Medicaid formula would amount to $429 million less federal money to Maine over 10 years in the House bill, according to an analysis released this week by Health Management Associates, a Boston-based consulting firm. Maine would be forced to make cuts in Medicaid or other state programs, or raise taxes to make up the difference.

“The pressure on states would be enormous,” said Austin, the Maine Hospital Association vice president.

Collins told the Press Herald last week that she was concerned about the impact of changing the Medicaid funding formula on Maine, saying doing so would have “enormous implications.” Rural Maine would be hit especially hard, as the outlying areas of the state are more reliant on Medicaid funding for health services. Rural hospitals would be under more financial stress if the Senate bill were to be approved.

Collins spokeswoman Annie Clark said the senator will “carefully review the text of the Senate health care bill this week and into the weekend.”

“She has a number of concerns and will be particularly interested in examining the forthcoming CBO analysis on the impact on insurance coverage, the effect on insurance premiums and the changes to the Medicaid program,” Clark said in a statement. “She has met with and heard the concerns of many Mainers about their health care challenges, and she will continue to do so as she studies the impact of this legislation on Maine and the nation.”

The bill also de-funds Planned Parenthood, which Collins has said she’s against.

Collins opposed the House version of the bill after the CBO score revealed that 23 million fewer Americans would have insurance.

Collins, a moderate, is considered a key vote in a closely divided Senate, where Republicans hold a 52-48 advantage. She and several moderate Republicans – including Lisa Murkowski of Alaska, Dean Heller of Nevada and Shelly Moore Capito of West Virginia – have expressed reservations about the ACA replacement bill.

The bill also changes the subsidies for those who obtain insurance on the ACA’s individual marketplace. About 80,000 Mainers have insurance through the ACA individual marketplace.

Spokesmen for Community Health Options, the company that writes most of the individual policies issued on the Maine marketplace, could not be reached for comment on the Senate health bill.

The tax credits used to purchase individual insurance would end at 350 percent of the federal poverty limit, instead of 400 percent. Under the Senate bill, a single person would no longer qualify for subsidies if he or she earned about $42,000 per year, leaving them on the hook for thousands more in premium costs.

Under one scenario, a 60-year-old Portland resident who earns $42,330 would pay an additional $4,651 per year in premium costs than under the ACA, while a Bangor resident would pay $6,323 more, according to the Kaiser Family Foundation.

The Senate bill also leaves in place a provision in the House bill that allows insurers to charge older people five times more for premiums than someone in their 20s, which would result in much higher premiums for adults in the 50-64 age bracket. The ACA permits insurers to charge older enrollees three times as much.

Butterfield said the Senate bill’s tax credits are based on “bronze” plans with higher deductibles and co-pays than the “silver” plans that ACA subsidies are based on. So in many cases enrollees would be paying more for less, he said.

“Premiums are going to be going through the roof, and people will have sky-high deductibles,” Butterfield said.

The bill includes $2 billion for opioid treatment funding for 2018, a “drop in the bucket,” according to Malory Shaughnessy, executive director of the Alliance for Addiction and Mental Health Services, Maine.

A proposal by Republicans Capito and Rob Portman of Ohio to fund $45 billion for opioid treatment was not included in the bill.

Maine and much of the nation are in the midst of an opioid crisis. Maine averaged one drug overdose death per day in 2016, an all-time high.

Shaughnessy said there’s not enough access now in Maine to opioid treatment, and cutting Medicaid will only make access worse.

“Everywhere you turn, people do not have access to treatment and are trying to get it,” she said. “The more we cut back, the less access we will have.”

Shaughnessy said the opioid crisis is getting “lip service, but not a lot of action.”

Joe Lawlor can be contacted at 791-6376 or at:

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