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AAFP cites ‘significant concerns’ over American Health Care Act
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The AAFP has sent a letter to the leaders of the House Budget Committee, stating that unless major changes are made to President Donald J. Trump’s health care replacement plan, it may not support the proposal.
“The AAFP continues to have significant concerns with the legislation in its current form,” Wanda Filer, MBA, MD, board chair of the AAFP, wrote. “Our concerns are primarily focused on the significant loss of health care coverage that will be experienced by millions of Americans should this legislation become law.”
In a press release, HHS provided some details about the replacement plan, known as the American Health Care Act (AHCA). The plan will add flexibility and increase contribution limits to health savings accounts and provide patients with meaningful access to care, the agency stated.
Filer objected to HHS’ use of the word “access,” writing that is not enough of an assurance.
“The AAFP strongly disagrees with suggestions that the AHCA will provide every American ‘access to health care coverage.’ ‘Access to health care coverage’ is distinctly different than ‘securing health care coverage.’ The AAFP’s goal is to ensure that every American ‘secures health care coverage,’” she wrote.
Some of Filer’s concerns were supported by the report from the Congressional Budget Office (CBO), which estimated that 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. The AMA also sharply criticized the health care plan, based in part on the CBO analysis.
In a statement, HHS Secretary Tom Price, MD, said the assumptions made in the CBO report regarding coverage are not realistic and do not accurately reflect the outcomes of the bill.
“The CBO report’s coverage numbers defy logic,” he stated. “[It] 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.”
Neither the HHS nor the Trump administration have provided details on further proposed legislative action on health care.
The HHS also said its plan will lower costs, increase access to coverage options and allow financial assistance to lower premiums, but Filer disagreed. She wrote that the CBO projected that the people’s share of medical services paid in the form of deductibles and other cost sharing would increase under AHCA. As a result, the CBO predicts that fewer lower-income people would obtain coverage. Citing research that has shown AHCA will cause financial hardship, she also expressed a desire that lawmakers keep health care affordable.
“We are concerned that [AHCA] would compound the economic strain on a large percentage of individuals and families — requiring them to spend a larger percentage of their income on premiums and deductibles and thus leading to greater financial insecurity,” Filer wrote.
She also proposed guaranteeing accountability and accessibility in Medicaid and keeping that program from becoming “an administrative morass that will expose both beneficiaries and health care providers to unnecessary and costly proceedings.”
Filer also expressed dismay with AHCA’s current plans to eliminate the federal guarantee of access to addiction and mental health services for millions of low and middle income individuals as well as the proposal that would ban Medicaid payments for some health care professionals and facilities, meaning millions of women would lose access to essential health care.
The budget outline released by the White House subsequent to the AAFP’s letter said the administration planned to fund the Substance Abuse and Mental Health Services Administration’s substance abuse treatment activities, including a $500 million increase above 2016 levels to expand opioid abuse treatment.
Although the HHS said AHCA will expand patients’ choices so they can choose a health care plan that fits their needs and see the doctor that they want, Filer encouraged more steps be taken. She asked lawmakers to consider every primary care physician in-network, so that relationships between these doctors and their patients can grow. As AHCA is currently written, she stated, there are no such provisions in place.
Price said the replacement plan will strengthen patient–doctor relationships and put more medical decisions in the hands of those two people.
“The doctor–patient relationship is the most sacred part of our entire health care system. ... Under the current health care law, that relationship is being undermined,” he said after a “listening session” earlier this week with doctors, medical professionals and small-business owners who said the current law is failing them. “The [AHCA] will restore, protect and preserve the doctor–patient relationship — the trusting partnership that is fundamental to quality health care. Our reform effort will ensure patients and physicians are the ones making medical decisions, not Washington, and provide relief to those being harmed by the current health care system.”
Although Filer stated there are several components of AHCA consistent with AAFP ideals, particularly those regarding insurance underwriting, coverage for individuals with pre-existing conditions and what she called an acknowledgement of Medicaid’s poor payment rates, she concluded by writing that the AAFP may not be able to support the bill as currently written.
“We hope the recommendations provided in this letter assist you in modifying the legislation in a manner that will protect the progress we have made as a nation over the past 2 decades,” she wrote. “However, if major changes are not made to the AHCA by your Committee to fully address the recommendations and concerns noted above, the AAFP will consider opposition to its passage.”
The letter is the latest request AAFP has made of the new administration. Earlier this year, it asked President Trump to reduce some of the regulatory burden placed upon its members so that they can devote more time to patients. – by Janel Miller
References:
http://www.aafp.org/news/government-medicine/20170315ahcaletter.html
Disclosure: Healio Family Medicine was unable to determine relevant financial disclosures prior to publication.