April 27, 2017

Doctors' groups say draft AHCA amendment could reduce US residents' access to care

Daily Briefing

    A coalition of six physicians' groups on Wednesday sent a letter to Congress expressing concerns about the House GOP's latest draft amendment to the American Health Care Act (AHCA).

    The draft amendment would allow states to apply for waivers that would let insurers charge older adults more for coverage, charge more to some beneficiaries with pre-existing conditions, and alter the ACA's Essential Health Benefits requirements. Specifically, the draft amendment would allow states, after Jan. 1, 2020, to apply for waivers to set their own essential health benefits for plans in the individual and small group markets—rather than the national set of benefits outlined under the ACA, which include hospitalization and rehabilitation.

    According to Axios, the House could vote on the AHCA as early as Friday, but House Republican leaders have said they will not hold a vote until they are confident they have the 216 votes needed to advance the measure.

    The draft amendment has led some conservative lawmakers, who previously had opposed the ACHA, to support the bill, but some moderate Republicans have said they remain opposed to the measure, Axios' "Vitals" reports. Rep. Charlie Dent (R-Pa.), co-chair of the moderate Tuesday Group, said, "My own sense is that many of our members who were opposed to the bill are probably still opposed."

    Physicians express concerns

    The physicians' groups in the letter wrote that the draft amendment's proposals "would dramatically increase costs for older individuals, result in millions of people losing their health care coverage, and return to a system that allows for discrimination against people with pre-existing conditions."

    Further, the groups wrote that the proposals could limit individuals' access to care, adding that before the ACA was implemented, some U.S. residents could not access mental health care and substance use disorder treatment. "This experience with the health care system is why our organizations strongly oppose the compromises" included in the draft amendment, the groups wrote. They added that such services currently "are needed more than ever to address the opioid [misuse] epidemic in the United States."

    In addition, the groups wrote that proposals to encourage states to create high-risk pools for sick individuals have "been proven ineffective numerous times," writing that the pools likely would be underfunded.

    Study: Eliminating ACA cost-sharing payments could cost federal government billions

    The groups concluded that although the U.S. "health care system is not perfect and reforms are needed," the proposals included in the draft amendment would not help to improve the health system.

    The letter was signed by the:

    • American Academy of Family Physicians;
    • American Academy of Pediatrics;
    • American College of Physicians;
    • American Congress of Obstetricians and Gynecologists;
    • American Osteopathic Association; and
    • American Psychiatric Association.

    Bill could face hurdles in Senate

    Even if House Republicans are able to get enough support from moderates to pass the AHCA in the House, the bill could still face opposition from some Senate GOP lawmakers, Politico reports.

    Sen. Rand Paul (R-Ky.) on Wednesday said the House Freedom Caucus, which officially endorsed the latest amendment, "has done a good job of trying to make the bill less bad," but added that he remains concerned the bill would continue giving "taxpayer money … to insurance companies."

    Phil Novack, a spokesperson for Sen. Ted Cruz (R-Texas), said "significant work" will need to take place on the measure if it advances to the Senate, "specifically to address [the ACA's] insurance mandates and enact major patient-centered reforms that will further reduce the cost of health care."

    Senate Majority Whip John Cornyn (R-Texas) also indicated the Senate could seek health reform proposals that would differ from those included in the House's version of the AHCA.

    "Once they pass a bill, my assumption is, the Senate's going to take a look at it but not necessarily be rubber-stamping what they're proposing," he said. "So I would anticipate that we'll do what we used to do all the time which is, the House will pass a bill, we'll pass a bill and then we'll reconcile those in a conference committee" (Lee, Modern Healthcare, 4/26; Owens/Swan, Axios, 4/26; Nather, "Vitals," Axios, 4/27; Cornwell/Abutaleb, Reuters, 4/26; Mershon/McPherson, Roll Call, 4/26; Bade/Bresnahan, Politico Pro, 4/27 [subscription required]; Kim/Everett, Politico, 4/27).

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    Stuart Clark, Managing Director

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