Continue Reading Dr. Melinda Buntin of Vanderbilt School of Medicine on “Trickle-Down Health Policy”"/>

Dr. Melinda Buntin of Vanderbilt School of Medicine on “Trickle-Down Health Policy”

On May 4 the House of Representatives passed the American Health Care Act (AHCA), which makes many changes to the Affordable Care Act (ACA), signed into law under the Obama administration. Now with the legislation under consideration in the Senate, there are many questions and uncertainties among healthcare providers, insurance companies, employers, and consumers as to what the proposed changes could mean for them.

We invited Dr. Melinda Buntin of the Vanderbilt School of Medicine to talk through some of these proposed changes with us, and anticipate how they might affect our region.

About 100 people representing public health, health systems, insurers, employers, government leaders, and consumers gathered in The Health Collaborative’s Learning Center as Dr. Buntin outlined the major changes to insurance rules and healthcare coverage proposed under the AHCA, comparing them with current standards set by the ACA.

Buntin explained that many of the protections built into the ACA for low-income and under-resourced populations such as the elderly, the disabled, and the very young are at risk under the proposed AHCA bill. The “Trumpcare” bill, as the AHCA is sometimes referred, would reduce spending on safety-net programs for the poor, such as healthcare coverage and food assistance, in favor of balancing the budget in 10 years and increasing military & defense spending – creating concern among those who provide and receive safety-net benefits.

Dr. Melinda Buntin
Dr. Melinda Buntin

As Buntin described, the Congressional Budget Office (CBO) has evaluated the effects of an earlier version of the AHCA, finding that, if passed, it would cause 24 million more Americans to become uninsured by 2026. It would also reduce Medicaid spending by $880 billion over the next 10 years, adding 14 million enrollees to the numbers of uninsured. Dr. Buntin’s talk was prior to the CBO’s May 25 analysis of this version of the bill (click here to read the CBO report).

There may also be an impact on the healthcare workforce, says Buntin: if the Medicaid expansion is rolled back and other healthcare funding is cut, there will be fewer consumers seeking care, putting more healthcare jobs at risk.

Other changes to federal healthcare funding proposed by the AHCA include:

  • New: patient and state stability fund; safety net in place for states that choose not to expand Medicaid; and supplemental funding for community health centers
  • Repealed: taxes imposed by the ACA; preventive and public health funding; and Medicaid funding for Planned Parenthood (repealed for one year)
  • Fixed block grant option: rather than guaranteeing states a fixed percentage reimbursement (typically over 90%) on total spending, changes to Medicaid would give states a fixed amount of money to share the risk when costs and/or the number of Medicaid enrollees increase

Now under consideration in the Senate, there is a chance, says Buntin, that the bill will be returned to the House with changes in time for the July 31 Congressional summer recess, but the House is currently working to revise portions of the bill that were found by the CBO to cause unacceptable budget deficits.

About Dr. Melinda Buntin

Melinda Buntin joined Vanderbilt School of Medicine in 2013 as the Chair of the new Department of Health Policy. She was previously Deputy Assistant Director for Health at the Congressional Budget Office, where she evaluated legislative proposals and directed studies related to healthcare financing.

Dr. Buntin’s work at Vanderbilt is focused on healthcare delivery and costs, with an emphasis on improving the value created by the healthcare system. She currently serves on the Department of Health & Human Services Technical Review Panel on the Medicare Trustees Report, as well as the National Academy of Medicine’s Board on Health Care Services.

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