Ken Terry

June 13, 2017

CHICAGO ― It is well known that the American Medical Association (AMA) advocates for a free-market healthcare system, not for a government-run, single-payer system; it wants patients to have free choice of doctors and health plans, and it opposes price controls.

And, according to the AMA's chief lobbyist, Richard Deem, who on Saturday briefed the association's annual House of Delegates meeting being held here about the Republicans' current healthcare reform legislation in Washington, the group also opposes the new legislation called the American Healthcare Act (AHCA).

The AMA, which supported the Affordable Care Act (ACA) in 2010, vociferously opposes the AHCA because of its cuts to federal healthcare financing and its potential impact on patients. As AMA President Andrew W. Gurman said earlier on Saturday, "While we might debate the appropriate ways to fix the ACA, we continue to support the goal of making healthcare more affordable and accessible for everyone and better protecting patients from the devastating financial costs that can result from a health emergency or a serious illness."

The US House Republicans' bill, according to Deem, the AMA's senior vice president of advocacy, would do just the opposite. The legislation might lower premiums on the insurance exchanges, but lower premiums may come with higher deductibles and skimpy coverage, he said. Many states want to keep the Medicaid expansion with a 90-10 federal-to-state match, but the House bill would phase it out in 2 years. Although the Senate Republicans are talking about extending that to 3 or even 7 years, some states may pull out right away if they expect the feds to snatch the match away from them, he noted.

The GOP also wants to convert Medicaid funding to state block grants that would cap the federal contribution. As a result, he said, state budgets won't be able to keep up with the costs of medical innovations. Over time, Congress could chop out even more funding. States would have to reduce their Medicaid rolls, forcing many people to resort to emergency rooms. And many rural hospitals will close their doors if Congress approves the AHCA's Medicaid changes, he predicted.

What Will the Senate Do?

Deem said he doubted that the Senate would follow the House on allowing states to waive preexisting condition requirements by allowing medical underwriting for people who have had gaps in coverage. But it's possible that the Senate might go along with the House bill's provision that permits states to waive the ACA's essential benefits requirement, he said. This could affect not only people in the individual market but also those who get their health insurance through employers, he added.

Asked by an audience member how the AMA is fighting the AHCA, Deem replied that the association's lobbyists are meeting with members of Congress all the time. Unfortunately, he said, the Republicans rammed their bill through the House without much public discussion. "They weren't interested in a lot of input from the healthcare community," he pointed out, adding that all of the major players in that community stand with the AMA on this issue.

If Senate Majority Leader Mitch McConnell thinks he has the votes to pass the Senate's version of the bill, Deem warned, it will go right on the floor of that chamber and could be passed within a week. At this point, he said, the bill's fate hangs in the balance, "and the stakes are very high."

The key to making real progress on healthcare reform, Deem stated, is for the Republicans to stop trying to repeal the ACA and work on fixing it instead. "If you set aside repeal, you could do a lot of things, such as changes in Medicaid, tax treatment of insurance, and bolstering the individual [insurance] market. But to get the tax reductions [that Republicans want], you have to gut Medicaid and subsidies to individuals."

In response to a question about the possibility of insurance exchanges folding in some states, Robert Neese, MD, a professor of family medicine at the Mayo Clinic, who moderated the session, pointed out that insurers need assurances that the federal government will continue to pay the cost-sharing reduction (CSR) subsidies they require to charge less to low-income people. With Congress and President Trump sending mixed signals on that front, he said, "some insurers are either exiting the exchanges or raising premiums very high."

Deem agreed. If the CSR subsidies were ensured, he said, rate hikes on the exchanges would be much lower than they are expected to be next year. Some Republican congressmen are starting to recognize this fact, he said. For example, Kevin Brady (R-Texas), chairman of the House Ways and Means Committee, recently said he believed the CSR subsidies should be continued.

Deems noted that 20 House Republicans voted against the AHCA, and he said the AMA remained open to working with Congressional members of both parties to improve the US healthcare system. But for now, the AMA's position on healthcare reform is aligned with that of the Democrats.

American Medical Association (AMA) 2017 Annual Meeting. Presented June 10, 2017.

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