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AMA, HHS disagree on CBO report

The AMA and HHS have recently released opposing statements about the Congressional Budget Office’s report on President Donald J. Trump’s replacement plan for the Affordable Care Act, known as the American Health Care Act, disagreeing on its accuracy and its assessment of the potential impact of the new health care bill.

The AMA stated that the report by the Congressional Budget Office (CBO) highlights its concern that the American Health Care Act (AHCA) will result in millions of Americans losing health care coverage. The Association of American Medical Colleges (AAMC) also issued a statement on the report, indicating that the loss of access to regular care due to the AHCA would put the American people’s health at risk and increase the burden on teaching hospitals where uninsured patients would likely seek care. On the other hand, HHS argued that the CBO report is inaccurate and does not account for future components of the administration’s plans for health care reform.

The Congressional Budget Office (CBO) projected that the American Health Care Act (AHCA) will cause 14 million to lose coverage in 2018, as well as increase the number of people without health insurance to 52 million by 2026, 24 million more than expected under the current law. In addition, the AHCA would reduce federal deficits by $337 billion, according to the CBO report.

In the early years of AHCA, the increase of uninsured people would most likely result from a majority of individuals dropping coverage voluntarily due to the elimination of the individual mandate or because of premiums that would be 15% to 20% higher than the ACA, according to the CBO. However, according to the report, premiums would be approximately 10% lower by 2026 than if the current law were to continue, and the rise of uninsured people would then be caused by cutbacks in Medicaid. The CBO report estimated that in comparison to the ACA, federal Medicaid spending under AHCA would be 25% lower, the number of Medicaid beneficiaries would be 17% lower and 14 million fewer people will be covered by Medicaid by 2026. In addition, many Americans, especially older adults, will have significantly higher deductibles and other out-of-pocket expenses under the AHCA due to its allowance of insurers to cover a reduced portion of medical costs, and its repeal of cost-sharing subsidies for low-income individuals in 2020, according to the CBO.

HHS Secretary Tom Price, MD, defended the AHCA, arguing that, “the CBO report’s coverage numbers defy logic.” He said the assumptions made in the CBO report are not realistic and do not accurately reflect the outcomes of the bill.

“The CBO report also does not incorporate two-thirds of the health care reform plan President Trump has called for — specifically the regulatory relief HHS can provide and the additional legislative reforms Congress is and will be pursuing,” he added. “Our three-pronged approach will free patients to purchase coverage that works best for them at a price they can afford. Doctors and patients understand that, especially under current law, having coverage is not the same thing as having access to the care one wants or needs. Our approach will provide Americans with relief from the collapsing health care law, which never delivered on the benefits projected by the [CBO] in the first place.”

Neither HHS nor the White House have provided details on what future reform proposals might include.

Conversely, Andrew W. Gurman, MD, president of AMA, said in a statement that the CBO’s report emphasizes the organization’s concerns about the currently proposed AHCA, calling its outcome of increased loss of coverage for millions of Americans “unacceptable.”

“While the [ACA] was an imperfect law, it was a significant improvement on the status quo at the time, and the AMA believes we need continued progress to expand coverage for the uninsured,” he said. “Unfortunately, the current proposal — as the CBO analysis shows — would result in the most vulnerable population losing their coverage.”

“Importantly, we hope the CBO estimates will motivate all members of Congress to find a pathway to work together on significantly improving proposed health reform legislation so it is more focused on serving the very real needs of patients and improving the health of our nation,” Gurman concluded.

Darrell G. Kirch , MD, president and CEO of AAMC, said that the millions of Americans who would be left without access to regular health care and would have to pursue care at teaching hospitals may not seek care until they are in critical condition. Treating patients with more advanced disease would require more complex treatment at greater cost to the health care system and greater risk for patients.

“While some may point to the federal budget savings the AHCA would yield, the fact is these Americans will still need health care,” he said. “America’s teaching hospitals will continue to care for these vulnerable patients, but will be forced to absorb the resulting uncompensated care costs, threatening their ability to support and advance their research and education missions. This weakens — rather than strengthens — the health care safety net and the overall health of the nation.”

When the AHCA was first revealed, the ACP and AMA asserted that the bill was “unacceptable” and “critically flawed.” – by Alaina Tedesco

For more information:

https://www.cbo.gov/publication/52486

https://www.hhs.gov/about/news/2017/03/14/secretary-price-statement-cbo-report.html

https://www.ama-assn.org/ama-statement-cbo-estimates-health-reform-bill

https://news.aamc.org/press-releases/article/cbo_score_ahca_03132017/

Disclosure: Healio Internal Medicine was unable to confirm relevant financial disclosures at the time of publication.