ACA Repeal-Replace Bill Troubles Medical, Nursing Groups

March 08, 2017

Major medical societies such as the American Medical Association (AMA) worry that a House bill to repeal and replace the Affordable Care Act (ACA) will translate into fewer people with health coverage and the care they need.

Their objections to the bill, dubbed the American Health Care Act (AHCA), center on two key elements. They say that the bill's new tax credits for buying a private plan are less generous than those under the ACA, particularly for low-income Americans, a claim supported by a recent Kaiser Family Foundation analysis. They also are troubled by major changes to Medicaid — namely, a per-capita cap on the federal contribution to state programs, which could leave them underfunded, and a rollback of expanded eligibility in 31 states and the extra federal dollars that come with it.

"While we agree that there are problems with the ACA that must be addressed, we cannot support the AHCA as drafted because of the expected decline in health insurance coverage and the potential harm it would cause to vulnerable patient populations," AMA CEO James Madara, MD, wrote members of Congress yesterday.

Speaking for the American Nurses Association, President Pamela F. Cipriano, PhD, RN, FAAN, joined the dissent. "In its current form, the bill changes Medicaid to a per capita cap funding model, eliminates the Prevention and Public Health Fund, restricts millions of women from access to critical health services, and repeals income based subsidies that millions of people rely on. These changes in no way will improve care for the American people," she said in a prepared statement.

The American Nurses Association (ANA) joined the dissent. "In its current form, the bill changes Medicaid to a per capita cap funding model, eliminates the Prevention and Public Health Fund, restricts millions of women from access to critical health services, and repeals income-based subsidies that millions of people rely on," said ANA President Pamela Cipriano, PhD, RN, in a news release. "These changes in no way will improve care for the American people."

Other medical societies expressing similar criticisms and reservations include the American College of Physicians (ACP), the American Academy of Family Physicians (AAFP), the American Congress of Obstetricians and Gynecologists, the American Academy of Pediatrics, and the American Osteopathic Association.

The concerns about the AHCA extend to other quarters of the healthcare industry. Rick Pollack, president and CEO of the American Hospital Association, also wrote members of Congress that his group could not support the measure as drafted. And Georges Benjamin, MD, executive director of the American Public Health Association (APHA), said in a news release that the bill "would jeopardize the health and lives of millions of Americans."

The APHA noted that the ACA's Prevention and Public Health Fund accounts for roughly 12% of the budget of the Centers for Disease Control and Prevention. The loss of that money would undercut public health initiatives nationwide, according to the APHA.

In contrast, House Republicans describe their bill as rescuing Americans from a "collapsing" ACA. They point to rapidly rising premiums for health plans sold on the exchanges, the availability of only one insurer in a third of the nation's counties, steep and unaffordable deductibles for exchange plans, failed insurance co-ops, and onerous taxes. They also accuse the law of forcing Americans into health plans they do not want.

"While the Affordable Care Act, or Obamacare, has helped some, it has inflicted tremendous harm on more families, more workers and more job creators nationwide," said Rep. Kevin Brady (R-TX), chair of the House Ways and Means Committee, during a meeting on the bill today.

Some Praise

The bill has garnered a smattering of praise from at least one medical society, the avowedly conservative Association of American Physicians and Surgeons (AAPS).

"If it does repeal the mandates forcing individuals and employers to buy insurance that is overpriced and doesn't meet their needs, it's a step in the right direction," AAPS Executive Director Jane Orient, MD, told Medscape Medical News. However, Dr Orient called the House bill a "big disappointment" because it doesn't go far enough in creating a free market for health plans and healthcare spared of government interference.

If passed, the AHCA "will share responsibility for the continued deterioration of American medicine," she said.

Abortion Remains a Lightning-Rod Issue

Abortion continues to be a lightning-rod issue in the healthcare reform debate, as illustrated by organized medicine's critique of the AHCA.

Section 103 of the bill temporarily would cut off federal funding of Planned Parenthood. The provision would freeze otherwise mandatory payments for 1 year via Medicaid, the Childrens Health Insurance Program, and other federal programs to certain providers "designated as prohibited entities."

As defined in the bill, a prohibited entity is an essential community provider primarily engaged in family planning and reproductive health services and that provides abortions other than those in cases of rape, incest, or a pregnancy that endangers the woman's life.

In his letter to lawmakers, the AMA's Dr Madara said his group "cannot support provisions that prevent Americans from choosing to receive care from physicians and other qualified providers, in this specific case, those associated with Planned Parenthood affiliates, for otherwise covered services." The ACP and AAFP voiced similar misgivings, with AAFP Board Chairperson Wanda Filer, MD, saying in a letter to lawmakers that Section 103 is "an inappropriate intrusion into the patient-physician relationship."

Follow Robert Lowes on Twitter @LowesRobert


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