Trump Health Bill Rejected, But Fate of ACA on Shaky Ground

Ingrid Hein

April 04, 2017

The threat to repeal the Affordable Care Act, which would have left 24 million Americans without health insurance, has passed, but vigilance is still required in the regulatory and legislative arena to protect patients, according to experts at the American College of Physicians (ACP) Internal Medicine 2017 meeting in San Diego.

Nearly half a million physicians came together to lobby against the proposed American Health Care Act (AHCA)," said Robert Doherty, senior vice president of governmental affairs and public policy at the ACP.

"This bill would have rolled back historic gains in coverage"  and made private insurance unaffordable, said ACP President Nitin Damle, MD. "We were pleased the bill was withdrawn." Now we have to keep up the pressure so that Health and Human Services Secretary Tom Price upholds the current health system, he added.

"I am concerned. They've been calling to repeal or replace for 7 years now, and I think they still want to move forward," said Doherty. "It's not over till it's over," he warned. "We have to look for any indication that this might come back, and we have to continue to mobilize."

 
They've been calling to repeal or replace for 7 years now.
 

Next on the agenda is watching how the Republicans defend against a pending lawsuit that argues that cost-sharing for insurance is illegal. "Secretary Price is still defending that," Doherty reported. If these subsidies go away, some insurance companies are going to pull out. "By next year, you'll see a mass exodus," he predicted.

It remains to be seen whether the Republicans are going to encourage people to sign on to the Affordable Care Act or enforce the individual mandate, he said.

For the system to work as designed, it is particularly important to get young people to sign on. If the requirement to buy coverage is not enforced, young people "will stay out until they get sick," he explained. "That could create a death cycle for health insurance."

There are many ways the current administration could harm the system and then claim it is faulty, he warned. "They could argue that Obamacare is not sustainable and going to collapse because it's poorly designed," even if it is sabotage, he said.

There are currently more Americans with health insurance than ever before. "We have 8.2% of Americans without coverage — a historic low," Doherty reported. "That's 92% of the way to universal coverage. We need to build upon that and improve it, not repeal it."

The proposed AHCA would have had a deleterious effect on the funding of preventive care, including access to vaccinations. "The CDC would have lost the funds it needs to prevent infectious diseases," Doherty pointed out.

The ACP is also keeping a watchful eye on other policy changes that could adversely affect healthcare, he told Medscape Medical News.

This week, the organization restated its position on climate change, reminding the Trump administration that "higher rates of respiratory and heat-related illnesses, increased prevalence of diseases passed by insects, water-borne diseases, food and water insecurity and malnutrition, and behavioral health problems" are all potential health effects of climate change.

In a previous statement, the ACP pointed out that President Trump's revised executive order on immigration still leaves Muslims open to discrimination.

"The ACP has grave concerns about the implications of the executive order on medical education, access to healthcare services, public health, and families," Dr Damle  said in a statement.

Until the proposed bill was withdrawn, "I was really concerned about patients in my practice," Dr Damle told Medscape Medical News.

He told the story of a 64-year-old patient who underwent quadruple bypass surgery after a heart attack. The cost for the patient's operation was $150,000. That patient's insurance would have been about $14,000 per year — half the patient's income — if the proposed bill had passed. "He would have become uninsured" and would have had to go bankrupt to have the operation, Dr Damle explained.

High Premiums

Although Republicans argue that the premiums for Medicare are too high, with the AHCA, premiums would have been even higher, and private insurers would have been allowed to opt out of basic coverage, Doherty pointed out.

In addition, the proposed bill would have allowed insurers to exclude people with pre-existing conditions, such as epilepsy and hepatitis C, and would have given insurers the right to take away essential benefits, such as preventive care, ambulance fees, maternity and newborn health, dental and vision, and rehabilitation services. "For insurance to be meaningful, these services have to be covered," Doherty said.

And women would have been penalized because coverage for maternity care would have cost extra and private insurers would have had the right to refuse coverage to women if they were pregnant, had previously undergone cesarean delivery, or had survived domestic violence. "Women would have paid more for insurance because they're women. That's now illegal," he said.

The AHCA also did away with cost-sharing requirements, so people with lower incomes would have paid the same premiums as those with higher incomes. For example, a person making $75,000 per year would have paid the same as someone making $15,000, Doherty explained. And tax credits didn't vary by place of residence. "You're disadvantaged if you live in a place where healthcare costs tend to be higher," he pointed out. This would have imposed a huge cost burden on the elderly.

Mr Doherty and Dr Damle have disclosed no relevant financial relationships.

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