Physician Practice

Physician groups sound off on ACA repeal and replace

Physician Practice Insider, March 21, 2017

Physician groups have weighed in on the American Health Care Act (AHCA), introduced by Republicans in the House of Representatives March 6.

The proposed legislation has stirred a storm of controversy from all sides, with some critics raising concerns about the Congressional Budget Office’s (CBO) predicted rise in the number of uninsured individuals and others saying the AHCA doesn’t go far enough to remove subsidies, tax credits, and other programs to help lower-income individuals obtain health insurance, CNN reported March 14. The AHCA would repeal the individual and employer mandates, restructure Medicaid, and delay the tax on high-value, employer-sponsored health plans. As politicians, lobbyists, and the public weighed in on the AHCA, the Medical Group Management Association (MGMA), the American Academy of Family Physicians (AAFP), and the American Medical Association (AMA) released statements on their positions.

The MGMA took a cautious stance in its March 8 statement. The association briefly covered the possible changes and stressed that the proposed legislation is still in its early stages and will likely undergo many changes if it passes.

The AAFP, however, voiced significant concerns. In March 8 letters to the House Energy and Commerce Committee and the House Ways and Means Committee, the AAFP said it supported several aspects of the proposed legislation, including the continuation of the Affordable Care Act’s (ACA) prohibition against insurers discriminating on the basis of race, gender, age, or health history, and provisions to help states address unacceptably low Medicaid payment rates. However, the association found more bad than good in the AHCA. The proposed legislation fails to address the affordability of healthcare and would require many to spend more of their income on premiums and deductibles, the AAFP said in its statement. Access to care, a concept that supporters of the AHCA have emphasized, is meaningless if that care is unaffordable, the AAFP said. The association also raised concerns about the AHCA’s failure to foster competition in the insurance market and the negative impact that lack of competition would have, particularly on rural communities.

The AAFP also criticized efforts to interfere with physicians’ ability to provide safe and effective healthcare services to women. It called aspects of the AHCA an inappropriate intrusion into the patient-physician relationship.

The AAFP expanded on its concerns in a March 14 letter to the House Budget Committee. The AHCA would roll back many recent advances, the letter said. By eliminating ACA measures to increase the number of individuals with insurance, the AHCA would see more patients in emergency departments with acute conditions rather than seeking preventive care with primary care physicians. That in turn would drive up healthcare spending. The proposed legislation would also hurt physicians by cutting back on Medicaid, according to the AAFP. More than 70 million individuals are now covered by Medicaid and 68% of family physicians accept new Medicaid patients, the AAFP said in its March 15 statement. The AHCA would also remove federal guarantees to access mental health and addiction treatment for Medicaid beneficiaries in states that expanded Medicaid under the ACA. This could be particularly damaging at a time when many states are struggling with widespread opioid addiction crises, the AAFP warned.

In a March 7 letter to congressional leaders, the AMA expressed concerns that the AHCA will limit provider choice and increase the number of uninsured. The AMA expressed particular concern regarding the AHCA proposal to award advanceable, refundable tax credits based on age rather than income, as they are under the ACA. The AMA’s letter echoes the AAFP’s stance on cuts to Medicaid and mental health and substance abuse treatment. The letter also raised alarm about the proposed repeal of the Prevention and Public Health Fund, a Centers for Disease Control and Prevention (CDC) program that supports investment in immunization, preventing childhood lead poisoning and healthcare-associated infections, and other public health issues. The Prevention and Public Health Fund currently makes up approximately 12% of the CDC’s budget.

Some physicians expressed concerns that an increase in the number of uninsured individuals could hit their bottom line. In the February issue of Physician Practice Perspectives, physicians discussed how the expansion of Medicaid and tax credits based on income helped them add patients to their practice and offset rising operational costs. Prior to the ACA, some physicians provided uncompensated care to uninsured patients and may find themselves returning to that model if the CBO’s analysis bears out.

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