AAFP, ACP Urge Senate to Halt AHCA

The American Health Care Act (AHCA) does not have many fans in the medical community.

Among other things, the bill would replace the subsidies that the ACA provided for low-and-middle-income families with a tax credit, end the Medicaid expansion program in 2020, and increase the amount insurers can charge older consumers compared to younger ones from three times the amount to five times. The bill, passed through the House on May 4 by a vote of 117 to 113, has moved on to the Senate despite its critics.

"I can't say anything good about the AHCA….I cannot," says John Meigs, Jr., MD and President of the American Academy of Family Physicians (AAFP) during an exclusive interview with Physicians Practice on Tuesday.

The AAFP is one of many medical groups including the American Medical Association (AMA), American Academy of Pediatrics (AAP), American Congress of Obstetricians and Gynecologists (ACOG), and the American College of Physicians (ACP), which have voiced their concerns with the AHCA.

"To put it mildly, we are extremely disappointed, I think the bill that passed the House will increase the cost [of healthcare] for patients, increase the cost [of healthcare] for the uninsured, and put patients with preexisting conditions at greater risk of potentially losing insurance," says Meigs.

AMA President Andrew Gurman, MD, voiced similar concerns in an email to Physicians Practice, noting that the AHCA would result in millions of Americans losing access to "high-quality, affordable health insurance." Gurman also said those with pre-existing health conditions face the possibility of going back to the time when insurers could charge them premiums that were unaffordable.

Both the AMA and the AAFP would like to see the Trump Administration work to improve the ACA, instead of moving forward with the AHCA. "We hope the AHCA is dead on arrival in the Senate. We would prefer to work with existing legislation and find ways to make improvements there….let's start with a clean slate and do what needs to be done. The ACA is not perfect, we never claimed it was perfect, but, it did expand coverage," says Meigs.

Amid all of the changes proposed by the AHCA, the physician advocacy groups both say people losing coverage is their biggest concern. "It has been policy of the AAFP since the 1980s that we are supportive of healthcare coverage for all Americans. We have advocated for and will continue to pursue policies that expand access to healthcare coverage for all Americans. That was the reason we supported the ACA, even with its flaws," says Meigs.

The AMA pointed out that in addition to many people losing coverage, the AHCA does not address problems such as choice and affordability of coverage for those who do not qualify for subsidies.

There were two amendments made to the AHCA after it failed to garner enough votes to pass in late March. The first was from moderate Tuesday Group leader Tom MacArthur, (R-N.J.), and conservative House Freedom Caucus Chairman Mark Meadows, (R-N.C.), granting states waivers allowing insurers to charge higher premiums to people with pre-existing illnesses whose coverage had lapsed. The second amendment was from Moderate leader Rep. Fred Upton (R-MI), and included an extra $8 billion over five years to cover those with pre-existing conditions.

Although these amendments were enough for passage in the House, medical groups do not believe these amendments are sufficient. "[The AHCA] is an example of politics over people. People need healthcare coverage that amounts to something and that they can afford. We send these folks to Washington to solve problems, not create them," says Meigs, who also made it clear that the AAFP does not believe in high-risk pools.

"I could be wrong, but I can't remember a successful high-risk pool. If all you have in the high-risk pool are the folks with the greatest risk, the coverage is going to be unaffordable. Unless, you have so much money you didn’t need it in the first place. You need healthy folks in the pool to dilute the costs of the sick so everyone can afford coverage. High-risk pools sound good, they just don't work."

The AMA views high-risk pools differently, writing, it has seen high-risk pools work effectively if they are adequately supported. However, if premiums skyrocket due to medical underwriting, budget constraints limit the number of people who can purchase coverage, or premiums are held down through mechanisms such as annual or lifetime benefit caps, these pools are not going to be sufficient to help patients with the greatest need, AMA says. 

This week, the AAFP will join members of the AAP and ACP, among others, in Washington to meet with the Senate on the bill. "Between the 6 organizations that will be in Washington, we represent over 500,000 physicians in this country. That is the majority of the primary-care in this country. We hope that with strength in numbers the Senate will listen to us," says Meigs.