ACA Repeal Passes First Hurdle, Moves to Senate

The American Health Care Act (AHCA), the Republican-created legislation that would repeal certain parts of the Affordable Care Act (ACA), passed the House yesterday by a vote of 217 to 213. It will move to the Senate, where it faces scrutiny, uncertainty, and a thinner margin of error.

The AHCA 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 latest iteration of the AHCA included amendments from moderate Tuesday Group leader Tom MacArthur, (R-N.J.), and conservative House Freedom Caucus Chairman Mark Meadows, (R-N.C.). The amendment grants states waivers allowing insurers to charge higher premiums to people with pre-existing illnesses whose coverage had lapsed. Moderate leader Rep. Fred Upton (R-MI) negotiated a second amendment to include an extra $8 billion over five years to cover those pre-existing conditions. This was enough to get enough Republicans on board to pass the bill.

Medical groups, such as the American Medical Association, were not happy that the AHCA moved forward in its current form. They cited the pre-existing conditions as the reason why they didn't like the bill and thought it needed to be improved.

"The bill passed by the House today will result in millions of Americans losing access to quality, affordable health insurance and those with pre-existing health conditions face the possibility of going back to the time when insurers could charge them premiums that made access to coverage out of the question," Andrew Gurman, AMA President, said in a statement.

Other provider advocacy groups such as the American Academy of Family Physicians and the American College of Physicians similarly spoke out against the AHCA after it passed the House. "It will destabilize our healthcare system, cause 24 million Americans to lose their coverage, and allow for discrimination against patients based on their gender, age and health status," AAFP President John Meigs, MD of Centreville, Ala., said in a statement.

Twenty Republicans voted against the AHCA. In the Senate, the AHCA faces a much thinner margin of error. Because of reconciliation rules in the Senate, the AHCA needs 51 votes to pass rather than the usual 60. If it gets 50 votes, Vice President Mike Pence would cast the tie-breaking vote to pass it. Ultimately, this means the Republicans can't afford more than two defectors if all Democrats vote against the bill.

Senate leaders say they will revise the bill before voting on it. If the Senate revises the bill, it will go back to the House for a final vote before heading to the President's desk.

High Prices Mean Nothing

High-price physician practices don't add any value, according to a study in Health Affairs. Researchers at Harvard Medical School used commercial claims data from the Consumer Assessment of Healthcare Providers and Systems survey to compare high and low-priced practices in the areas of care quality, utilization, and spending for Medicare beneficiaries. What they found was while higher-priced practices charged on average 36 percent more, there was no meaningful difference in overall care ratings, physician ratings, and access to care. Researchers say this calls into question the idea that high-priced practices deliver higher-value care.

Quote of the Week

The Damaging Culture of Medicine and Physician Suicide

"Doctors will admit to burnout because it's not in the [Diagnostic and Statistical Manual of Mental Disorders] and burnout is almost seen as a badge of courage. They're working hard, they're working in a difficult medical system, so they'll say they're burned out. However, very few doctors will admit they've been diagnosed with major depression, they're seeing a psychiatrist, and are taking time off from work until they get well…"

Michael Myers, MD, Professor of Clinical Psychiatry in the Department of Psychiatry & Behavioral Sciences at SUNY-Downstate Medical Center in Brooklyn, N.Y.