BLOG: Thoughts on the Better Care Reconciliation Act

On June 22, 2017, the U.S. Senate Republicans released details on the Better Care Reconciliation Act.

This act is very similar to the U.S. House version known as the American Health Care Act (AHCA). Both of these bills are part of the 115th U.S. Congress effort to repeal and replace the Affordable Care Act (ACA), popularly known as ObamaCare.

The essences of both of these bills is to reduce the cost burden of health care for American corporations and the wealthy. This is achieved by reducing funded coverage from the Federal budget and by shifting cost onto the states.

The states, however, will have options to eliminate some of the mandated benefits of the ACA known as essential benefits. These benefits include several of key importance to optometrists: rehabilitation services; preventive, wellness and chronic disease management; as well as the pediatric services that include eye and vision. It is this last benefit that established optometrists as essential primary care providers.

Although the American Optometric Association has not taken a formal position on the AHCA or the Better Care Reconciliation Act (BCRA), many other health care organizations have taken a hard line against these bills.

The American Public Health Association, in a press release on the very day of the public reveal of the BCRA, condemned the legislation and repeated its opposition to the AHCA. In the statement they noted, "We strenuously urge senators to oppose this bill and instead work for bipartisan solutions to improving our nation’s health."

Medical groups including the American Medical Association, American Academy of Pediatrics, American Lung Association, American Psychiatric Association and the American College of Emergency Physicians are among the many doctor-based organizations that are opposing the BCRA.

It is important to control the cost of American health care. One of problems with our system is that it is dramatically more expensive than any other country in the world. However, the legislation introduced by this Congress fails to address the problem in any meaningful way. I term these efforts as “slash and pass” bills. Slash health care coverage and pass the cost onto the states or consumers. These efforts are a failure of the Federal government to meet the main objective of their existence as required in the Preamble of the Constitution: to “promote the general welfare” of the people.

The core problem of the lack of wellness, health education and primary care with the emphasis on the urgent and emergent disease states and specialty care is virtually ignored in any of the 115th Congress efforts to date. In fact, these very issues, as addressed in the essential benefits of the ACA, are the ones being passes off on the states.

As modern optometrists with a huge role in primary care and an evolving role in prevention, chronic disease management and rehabilitation, we need to study these health care bills and take on active part in the political process. I would urge the AOA to study these issues in light of the future of our profession and take a position on the issues rather than just working to assure our traditional role in optical-based care.

These are critical times in the evolution of the American health care system. The future of our profession and the health and welfare of our patients are hanging in the balance.