Physicians reject House ACA replacement bill

Andrew W. Gurman, MD
American Medical Association
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The American Health Care Act (AHCA), released by Congress this week, is intended to repeal and replace the Affordable Care Act (ACA). But as introduced, it does not align with the health reform objectives that the AMA set forth in January to protect patients. While the ACA is imperfect, the current version of the AHCA is not legislation we can support.

The replacement bill, as written, would reverse the coverage gains achieved under the ACA, causing many Americans to lose the health care coverage they have come to depend upon.

In a letter sent today to leaders of the House committees that will mark up the AHCA, AMA CEO and Executive Vice President James L. Madara, MD, wrote that the proposed changes to Medicaid would limit states’ ability to respond to changes in service demands and threaten coverage for people with low incomes. Dr. Madara also noted that the proposed changes in tax credits and subsidies to help patients purchase private health insurance coverage are expected to result in fewer Americans with insurance coverage.

It is unclear the exact impact this bill will have on the number of insured Americans, and review by the nonpartisan Congressional Budget Office is still pending. The ratings and analytics firm S&P Global Ratings has already estimated that as many as 10 million Americans could lose coverage if this bill becomes law, saying that between 2 million and 4 million people could lose the insurance they purchased in the individual health exchanges under the ACA, and between 4 million and 6 million could lose their coverage under Medicaid.

That just won’t do.

We all know that our health system is highly complex, but our core commitment to the patients most in need should be straightforward. As the AMA has previously stated, members of Congress must keep top of mind the potentially life-altering impact their policy decisions will have.

We physicians often see patients at their most vulnerable, from the first time they set eyes on a newborn child to the last time they squeeze a dying loved one’s hand. We don’t want to see any of our patients, now insured, exposed to the financial and medical uncertainties that would come with losing that coverage.

That is, above all, why physicians must be involved in this debate.

Editor’s note: In the coming weeks, a series of AMA Wire® articles will explore policies that form the basis of the AMA’s advocacy on health reform. Read parts one (“Protecting insurance gains is priority No. 1”) and two (“No going back on key market protections”).

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I must respectfully disagree. The 10-year cost of the ACA has been projected to be $1.7 trillion dollars to society. The estimated expanded insurance coverage totals 18 million additional individuals. Therefore, it costs $94,000 to insure one additional person under the ACA. This is in no way, shape, or form, good stewardship of healthcare dollars. The result of the ACA has been skyrocketing insurance premiums that have put undue financial pressures on my middle class patients. In addition, due to market consolidation, hospitals and drug companies now have significant pricing power driving up costs. The ACA has resulted in significant practice costs that make independent practice increasing unsustainable. Doctors over the last several years have lost autonomy and practices are being consumed by hospital systems at an alarming rate. The AMA represents Doctors and many medical specialties are suffering due to increased administrative costs and regulations. We currently have a unique opportunity to work with a White House eager to deregulate industries across the board. Nearly 20-25% of all U.S. healthcare spending is tied to administration costs which totals nearly $500 billion dollars a year. Much of this spending provides no added value to our patients! As physicians we must find unique solutions to make healthcare affordable. The ACA is unsustainable and with the current Congress will be repealed. Burning political capital defending the ACA can lose the AMA a place at the table as new plans are being developed. Martin Palmeri, M.D., M.B.A.
From the front line as a FP, I agree with Dr. Palmeri. The ACA has benefited insurance companies more than patients. Two other issues: -The very high deductibles. Patients with plans under the ACA still have huge medical bills. -The lack of cost control. Under the pretense that more people have insurance, costs have just skyrocketed and greed is rampant. The AMA does not represent me on this issue.
I echo the statements of Drs Palmeri and Dretzer. The AMA is supposed to be our voice, but is bowing down to the media dribble. Insurance coverage means nothing if no physicians can afford to keep their practices open to care for the patients. I just closed my solo general surgical office because of the Unaffordable Care Act. Defensive medicine costs and insurance bureaucracy (profit) costs have continued untouched by the ACA, and this is where all of the moneys intended for health care are going. I have taken consistent reimbursement cuts over the last 30 years, and finally the last straw broke this camel’s back. The ACA was forced upon us without discussion. But the AHCA is open to discussion. The initial installment may not be what we would all prefer, but the President and Dr. Price are focusing in on the major cost culprits by pushing healthcare courts and selling insurance across state lines. Everyone against either of those two fixes are either in the pocket of the insurance industry or the trial lawyers. Randolph Lawrence, MD, FACS
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Oct 08, 2018
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