The ACR is joining a chorus of voices asking Congress to reconsider several key provisions in the proposed American Health Care Act (AHCA) that it feels could have a detrimental effect on patients.
Characterized as a replacement to the Affordable Care Act (ACA), the AHCA eliminates a number of provisions found in the ACA, although it does retain some of the ACA’s most popular provisions.
Major Concern: Access to Care
Like other medical groups, the ACR is glad to see several of the ACA’s most popular provisions are not repealed by the AHCA, such as no exclusions for coverage based on pre-existing conditions and coverage for children up to age 26 on their parents’ insurance.
“We are concerned that some provisions of the AHCA could make it harder for our patients to access rheumatology care,” said Sharad Lakhanpal, MBBS, MD, president of the ACR, in a statement issued on March 9.1
These provisions include replacing income-based subsidies under the ACA with fixed tax credits based on age rather than income, as well as imposing a 30% penalty on premiums for patients who lose coverage for more than 63 days.
Other Concerns: Access to Medication, Capping Medicaid
Expanding on those concerns, Angus Worthing, MD, chair of the ACR’s Government Affairs Committee, underscored that many patients under the proposed replacement bill could lose access to lifesaving and life-altering drugs, such as biologics. “These are virtually unaffordable without insurance,” he says.
Dr. Worthing also highlights concerns expressed by pediatric rheumatologists that the proposed bill would remove federal guarantees for Medicaid payments. Under the AHCA, states would be given a set amount of money per person (per capita cap) to spend on Medicaid recipients starting in 2020; this amount would grow yearly to account for inflation.
However, setting a cap on Medicaid dollars under such a formula is problematic. “Healthcare costs may increase faster than the proposed per capita Medicaid funding and leave poor children and families without coverage,” says Dr. Worthing.
Physician & Patient Groups Weigh In
In addition to the ACR, other medical groups have expressed concerns, including the American Medical Association (AMA), the American Hospital Association, the American College of Physicians (ACP), the American Association of Retired Persons (AARP) and most medical specialty groups.
In a statement issued on March 8, the AMA also highlighted concerns over the use of tax credits based on age rather than income for obtaining private health insurance coverage, as well as changes to Medicaid that could limit states’ ability to adequately cover low-income families, for example, changes to services needed for chronic conditions, such as mental health and substance abuse, as well as ongoing problems, such as opioid abuse and addiction.2, 3
In addition, the AMA is concerned about provisions in the bill that would repeal the Prevention and Public Health Fund and eliminate or restrict patients’ ability to choose their own providers, including access to affiliates of Planned Parenthood.
In the March 8 statement, AMA President Andrew W. Gurman, MD, encouraged Congress to ensure that people who need coverage get it and that those who have it get to keep it.
“We encourage you [Congress] to ensure that low- and moderate-income Americans will be able to secure affordable and adequate coverage and that Medicaid, CHIP, and other safety net programs are maintained and adequately funded,” he said.2
Among the low- to moderate-income Americans who may be at significant risk of receiving reduced access to care under the AHCA: senior citizens. In a letter to Congress, Joyce A. Rogers, senior vice president, government affairs, American Association of Retired Persons (AARP), detailed concerns over the increases to healthcare costs for Americans aged 50–64 in the new bill.4
Illustrating the detrimental effect of tailoring tax credits for obtaining private health coverage on age vs. income, Ms. Rogers pointed out that premium costs under the AHCA could increase by $3,200 for a person who is 64 years old. Putting even more meat on the proposed tax credit framework, she said that premium costs for a 64-year-old person earning $25,000 annually would increase to more than $4,400 per year—more than $5,800 per year if that person earns $15,000 annually.
“In addition to these skyrocketing premiums, out-of-pocket costs could significantly increase under the bill, with the elimination of cost-sharing assistance in the current law,” she said.
Ms. Rogers also highlighted concerns over Medicaid changes, underscoring that the per capita cap by state could overwhelm the ability of states to sufficiently shoulder the costs of care without federal support. “In terms of seniors, we have serious concerns about setting caps at a time when per-beneficiary spending for poor seniors is likely to increase in future years,” she said.
What to Expect
Along with pushback from providers and medical groups, House Republicans are facing opposition from other key players that could make the AHCA bill in its current form difficult to pass.
“Despite moving quickly in its first week in the House, the AHCA may face headwinds later from opposition within the Republican party, and there’s a possibility the Senate Parliamentarian could remove portions of the bill that do not pertain to budget reconciliation,” says Dr. Worthing.
Another hurdle may be the newly released Congressional Budget Office (CBO) report that puts real numbers on what can be expected if the bill in its present form is passed into law. According to the CBO report, 14 million people would lose coverage in 2018 under the proposed AHCA, a number that would climb to 24 million in 2026.5
For Dr. Worthing, this provides ample time for advocacy efforts. “There is time for the rheumatology community to advocate for our profession and our patients by sharing our views with members of Congress,” he says, assuring ACR and ARHP members that such advocacy is already being done on behalf of rheumatologists, rheumatology professionals and patients.
Mary Beth Nierengarten is a freelance medical journalist based in Minneapolis.
References
- American College of Rheumatology. AHCA does not go far enough to help Americans with rheumatic diseases. 2017 March 9. http://www.rheumatology.org/About-Us/Newsroom/Press-Releases/ID/798/ACR-AHCA-Does-Not-Go-Far-Enough-to-Help-Americans-with-Rheumatic-Diseases.
- American Medical Association. AMA says American Health Care Act is critically flawed. 2017 March 8. https://www.ama-assn.org/ama-says-american-health-care-act-critically-flawed.
- American Association of Retired Persons. Letter to Congress. 2017 March 7. http://www.aarp.org/content/dam/aarp/politics/advocacy/2017/03/aarp-letter-to-congress-on-american-healthcare-act-march-07-2017.pdf.
- Congressional Budget Office. American Health Care Act:Budget Reconciliation Recommendations of the House Committees on Ways and Means and Energy and Commerce. 2017 March 13. https://www.cbo.gov/publication/52486.
