(AP/J. Scott Applewhite)

Medicaid's chief doctor breaks with department in protest, as Republicans ram through Trumpcare

In the pre-dawn hours Thursday, the GOP's Obamacare replacement bill cleared a crucial House panel

Sophia Tesfaye
March 9, 2017 11:35PM (UTC)

Late Wednesday, as members of the House Ways and Means Committee were in the midst of a nearly 18-hour long markup of Republicans' bill to repeal and replace the Affordable Care Act, the chief medical officer for the Center for Medicaid and CHIP Services (CMCS) broke with the Trump administration to publicly oppose the White House-backed legislation. The GOP's so-called American Health Care Act (AHCA) passed out of committee on a party-line vote only hours later, and only days after it was first publicly released.

“Despite political messaging from others at HHS, I align with the experts from [American Academy of Family Physicians, American Academy of Pediatrics and American Medical Association] in opposition to #AHCA," Andrey Ostrovsky wrote on Twitter.


Ostrovsky's tweet is a direct rebuke to statements from his boss, Department of Health and Human Services Secretary Tom Price, who touted the bill as a better alternative to the Affordable Care Act. Ostrovsky has served as chief medical officer for Medicaid and the Children’s Health Insurance Program (CHIP) since October. He noted that his opposition aligns with experts from several doctors' groups, including the American Academy of Family Physicians, the American Academy of Pediatrics and the American Medical Association. Even the insurance industry’s largest trade association, America’s Health Insurance Plans, complained that Republicans' planned changes to Medicaid could produce “unnecessary disruptions in the coverage and care beneficiaries depend on.”

The GOP’s plan to replace what they derisively refer to as Obamacare would overhaul Medicaid in a way that dramatically shifts the cost burden to already low-income patients and ends the program's expansion under Obamacare in 2020, potentially cutting off access to health care for millions. One three-paragraph provision in the GOP's 66-page bill drastically reduces the length of retroactive coverage granted to qualified low-income participants in Medicaid, as Stat News' Dylan Scott points out. This means that a low-income woman who applies for Medicaid after becoming aware of a pregnancy could still be on the hook for the full pricetag of any medical costs incurred before she is approved for coverage. As Scott reported, health care experts agree that the retroactive protection for Medicaid recipients is important because those patients "are generally living in or near poverty . . . because they often don’t know that they’re eligible for the program until they get sick and go to the hospital or a doctor."

Despite objections from health care experts and even as the Senate’s top Republican expressed concern about the absence of a cost estimate from the Congressional Budget Office, House Republicans rushed to ram through the proposed legislation — giving the bill its first procedural victory less than 72 hours after introducing it.


Since the GOP's ObamaCare replacement plan was first unveiled on Monday night, it has faced swift and deafening backlash from the party's conservative base.

“This is exactly the type of back-room dealing and rushed process that we criticized Democrats for,” Utah Republican Sen. Mike Lee complained on Twitter almost immediately after the bill's release Monday night.

While opposing the Affordable Care Act in 2009, now-House Speaker Paul Ryan demanded that the CBO issue an analysis on Democrat's bill before the relevant House panels could even vote on the bill.


“GOP shouldn’t act like Dems did in [Obamacare],” Arkansas Republican Sen. Tom Cotton complained on Thursday morning. (The Affordable Care Act, however, received a score from the CBO days before debate began in 2009.) "No excuse to release bill Mon night, start voting Wed. With no budget estimate!" he tweeted:

Cotton's state of is one of 34 and the District of Columbia that expanded its Medicaid expansion under Obamacare. House Republicans' plan phases out Obamacare’s Medicaid expansion and caps Medicaid spending provided to states by the federal government even though only 12 percent of Americans support cutting Medicaid, according to a recent Kaiser Health Tracking Poll.


In addition to dismantling the medical safety net for America's poor and lower-income, Republicans on the Ways and Means Committee rejected Democratic amendments requiring that no American lose health coverage and that out-of-pocket costs for older Americans are not increased under any final legislation signed by President Donald Trump.

In a letter Wednesday, the American Hospital Association (AHA) urged Republicans to another way to improve health care for the poor, elderly and disabled. Under the Republican plan, a 50-year-old with an annual income of about $11,880 could pay over $1,000 more in penalties for not having insurance in the prior year than what she would pay for not having insurance under the current law.

“They don’t want the American people to see the facts,” House Minority Leader Nancy Pelosi said of her Republican colleagues after the AHCA passed the Ways & Means Committee Thursday morning. “They’re always afraid of the facts.”


Sophia Tesfaye

Sophia Tesfaye is Salon's Deputy Politics Editor and resides in Washington, D.C. You can find her on Twitter at @SophiaTesfaye.

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