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For now, GOP plan doesn’t touch Md. hospital payment system

In this Tuesday, Sept. 6, 2016, file photo, an American flag flies over Capitol Hill in Washington, as lawmakers return from a 7-week break. (AP Photo/Susan Walsh, File)

In this Tuesday, Sept. 6, 2016, file photo, an American flag flies over Capitol Hill in Washington, as lawmakers return from a 7-week break. (AP Photo/Susan Walsh, File)

The Maryland health care community remains in wait-and-see mode after House Republicans’ plan to repeal and replace the Affordable Care Act didn’t remove or eliminate Maryland’s demonstration authority, also known as the Medicare waiver.

The Republican plan, called the American Health Care Act, focused on coverage, leaving uncertain the status of Maryland’s all-payer model that governs hospital services in the state.

But many Maryland medical groups found enough with the bill they don’t like to oppose the measure.

“Without estimates from CBO of the impact on the federal budget or, more important, the impact on the number of Marylanders with health care coverage, we, along with the rest of the nation’s hospitals, must oppose the bill,” said Jim Reiter, a spokesman with the Maryland Hospital Association. “Our No. 1 objective is preserving broad-based, continuous coverage for those who have it today.”

Republicans are trying to pass the bill through the reconciliation process in the Senate so they only need 50 votes instead of 60.

However, that requires bills stay on the subject of the budget. To meet those requirements, unrelated health care subjects — such as demonstration projects, which is technically what Maryland’s waiver is — were kept off the bill.

The White House and House Republicans plan two more phases of their health care plan that would see non-budget issues addressed.

In a letter to Republicans, Health and Human Services Secretary Tom Price said those issues include selling insurance across state lines, lowering prescription drug costs, providing flexibility in Medicaid for states to manage their programs the way they see fit and medical legal reforms.

While much of the focus on the bill has been about whether people will lose coverage and the cost of the legislation, much of that won’t be known until the Congressional Budget Office scores the bill.

However, the bill does cut funding to the Prevention and Public Health Fund, which constitutes about one-sixth of the budget for the Centers for Disease Control and Prevention and also provides grants for public health efforts in Maryland.

Since the passage of the Affordable Care Act in 2010, the fund has provided $88 million for prevention efforts in the state, according to Trust for America’s Health, a nonprofit focused on disease prevention. Through the fund, Maryland has received grants to prevent diabetes, heart disease and stroke and to build vaccination programs, among other efforts.

The trust estimates that Maryland could lose $85 million over the next five years that it would have received from the fund.

“Cutting these funds will hurt patients’ health in the short term and compromise national security in the long term,” said Dr. Leana Wen, the Baltimore City health commissioner.

Wen also said she was concerned that the bill stripped funding for Planned Parenthood, blocking access to reproductive health services for women, families and children.

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