Senate Repeal Bill Threatens Primary Care Infrastructure

Categories: PCDC News, Policy
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Surprises are few in the Senate GOP’s bill to end Obamacare, which was released last week after a clandestine drafting process that excluded Democrats and many Republicans.

Echoing the House repeal bill — which President Trump recently described as “mean, mean, mean” — the new legislation would destabilize insurance markets, weaken the primary care system, and jeopardize the health of Americans.

The issue dominated a recent press conference at NYC Health + Hospitals, where the Primary Care Development Corporation (PCDC) joined Senate Minority Leader Chuck Schumer (D-NY) [pictured] and health advocates to underscore how the repeal bill threatens the primary care safety net. Specifically, the legislation would harm or close many hospitals, especially those in rural areas — keeping health care out of reach for even more Americans, according to Senator Schumer.

Without access to primary care providers and their critical services to prevent, identify, and cure illnesses before they become serious and costly, we all pay more into an unsustainable and untenable health care system that will leave all but the wealthiest behind.

The outcome is certain: repealing the Affordable Care Act would cause millions of Americans to lose their insurance coverage, see their premiums rise, and lose access to needed benefits.

Among the Senate bill’s many harmful changes are severe cuts and fundamental changes to the Medicaid program, and the elimination of the essential health benefits requirement — meaning insurance companies could offer plans that do not cover primary care benefits such as preventive care, maternity care, and mental health care.

While the bill does not allow insurers to directly discriminate on the basis of preexisting conditions, it excludes any form of a continuous coverage requirement, which would cause premiums to skyrocket as young healthy people choose to opt out of the marketplace. As with the House bill provisions, wealthy Americans would still benefit most, receiving billions in tax cuts.

Passage of the Senate bill is far from assured, as it will take just three Republican “no” votes to kill the legislation. A number of Senate Republicans are reported to be undecided, including far-right conservatives Rand Paul (R-KY), Ted Cruz (R-TX), and Mike Lee (R-UT) as well as more moderate members, such as Susan Collins (R-ME), Lisa Murkowski (R-AK), Rob Portman (R-OH), Shelley Moore Capito (R-WV), Jeff Flake (R-AZ), and Dean Heller (R-NV).

Despite sharp bipartisan criticism, Majority Leader McConnell is expected to rush a vote on the Senate bill next week. A Congressional Budget Office (CBO) score will be released before then, outlining the budgetary and coverage consequences of the proposed measures. The CBO’s earlier assessment of the House bill noted that 23 million fewer people would be insured in 2026.

As advocates for transforming primary care, we must take action to block the repeal efforts.

The most effective response is to call your Senators’ offices, especially if your representative is undecided on the issue. Be sure to ask to speak with the health legislative assistant. All calls are tallied and make a difference.

Now is the time to make our voices heard by urging elected officials to strengthen the primary care system and stop the Senate repeal bill.

Contact information for Senate offices can be found at:

Update: On June 26, the Congressional Budget Office estimated the Senate repeal bill will leave 22 million more Americans uninsured as well as confirmed the legislation guts Medicaid and will cause poor seniors’ premiums to skyrocket. Read the CBO’s cost estimate report.

Additional research and writing by Matt Kerschner.

About the Author:

Louise Cohen, MPH, Chief Executive Officer

Phone: 212-437-3917Email: Louise Cohen is the Chief Executive Officer of the Primary Care Development Corporation (PCDC), a not-for-profit community development financial institution dedicated to expanding and strengthening the primary care safety net in the United States. PCDC provides capital and technical assistance to a wide variety of primary care providers, and advocates for improved and increased primary care access, capacity, quality, reimbursement, and capital resources in order to improve health outcomes, create healthier communities, increase health equity, and reduce overall health care system costs. Prior to assuming leadership of PCDC, she was Vice President for Public Health Programs at Public Health Solutions in New York City (2011-2015), where she oversaw a variety of programs to improve community health through food access and nutrition, women’s reproductive health, tobacco control, and child development. Ms. Cohen held successive leadership positions at the New York City Department of Health and Mental Hygiene (DOHMH) from 1998-2011, including as Deputy Commissioner of the Division of Health Care Access and Improvement. Among her accomplishments at DOHMH, Ms. Cohen led the development and execution of Take Care New York, New York City’s first comprehensive health policy agenda. She also oversaw the Primary Care Information Project, which brought a public health and prevention-oriented ambulatory care electronic health record system to more than 2,500 primary care providers. Before her tenure at DOHMH, Ms. Cohen was Director of the Park Slope Family Health Center (now part of the NYU Lutheran Family Health Centers network). She served on PCDC’s Board of Directors from 2011 until she became CEO.