What Should Physicians Make of the GOP Health Bill?

The GOP's proposed legislation to repeal and replace the ACA was made public a week ago, and continues to be met with controversy. The bill, dubbed the American Health Care Act (AHCA), is being marked up in the House and dissected on the internet and in the media.

On Monday afternoon, the CBO score was released for the AHCA, finding that twenty-four million Americans would lose insurance by 2026 under the House Republican health care bill compared to the ACA, including 14 million by next year. Although the bill has a ways to go before it's approved, medical organizations have wasted no time weighing in. Amid all of the controversy, what are they saying physicians can take away from this proposed legislation?

 "There are still roughly 30 million people in this country without insurance…..we made great gains with the ACA from an uninsured number of about 50 million. We know that people without health insurance live sicker and die younger. If we go back and if we have fewer people insured as a result of the new proposal, that’s a step backwards," said David Barbe, MD AMA president-elect and practicing family physician in Mountain Grove, Mo., during an exclusive interview with Physicians Practice. 

Barbe's thoughts are hardly a surprise and echo the AMA's overall sentiment toward the proposed AHCA bill. The AMA has been a staunch supporter of the ACA since it was first implemented in 2010. They see the AHCA as a step backwards from a coverage perspective.

"It appears to us and I think most that have looked at [the proposal] critically…it threatens to undermine the coverage gains from the ACA. There would be fewer people with insurance, and fewer on Medicaid, if these proposals are implemented, and that concerns us greatly. Therefore we are not in a position to support the proposal in its current form," says Barbe.

The coverage expansion was the main reason the AMA supported the ACA in the first place. "We have appreciated the gains in coverage and the expansion of Medicaid that occurred under the ACA. Those were the primary reasons we supported the ACA back in 2010," says Barbe.

It is unknown if the repeal of the Medicaid expansion program or any of the AHCA's other proposals will see the light of day. The bill has faced opposition not just from medical groups, Congressional Democrats, but some prominent Republicans as well. Kentucky Senator Rand Paul initially called the bill "dead on arrival" and "Obamacare Lite" on Twitter.  This uncertainty has lead organizations like the MGMA to refrain from coming out with a reactionary stance on the proposed bill.

"For the most part, the initial reactions were somewhat negative or express some concern. I think that indicates some trouble on the horizon, my sense is that this is going to be a far lengthier process than is being conveyed. The fact is it’s a lot harder to work in reverse with the key stakeholder groups," said Anders Gilberg, Senior Vice President, Government Affairs at Medical Group Management Association (MGMA).

With the release of the CBO score, Gilberg believes it has become clear that Congress is attempting to do something they have never done before - take away benefits provided by a social program. "Colin Powell used the doctrine I would echo for what's happening here, there's a saying in Washington, 'if you break it, you own it.' Eventually [the Republicans] are going to own the new healthcare system if they push this through at the speed at which they are going. If they don’t step back and think about some of the opportunities to improve the legislation, and reduce the disruption it would cause in the delivery system, it's going to be perceived by many as taking away benefits that were previously provided," says Gilberg.

Gilberg was surprised that the administration moved forward with the proposal without conferring with providers, insurers, or patients beforehand. "Where I would say the administration and Congress made a serious error is that with virtually every legislation of this kind, you would bring in the main stakeholders, the providers, the insurers, the patients...you would bring them in prior to introducing the bill to at least achieve some type of consensus and some kind of inertia from a grass roots perspective towards achieving the goals of the legislation that meets the needs of multiple stakeholders," he explains.

Gilberg advises physicians to follow the MGMA's lead, take a deep breath and wait and see what happens with the newly proposed bill. "I would say take a deep breath, I think there are a lot of physician practices out there that are struggling with some of the real shortcomings of the ACA, such as the proliferation of insured patients with massive deductibles. It's as if many of those patients are still cash paying patients. There's a very legitimate argument that our members will remind us of everyday that yes there are patients with insurance, but that insurance for anything but catastrophic coverage is not useful for day-to-day preventive care," says Gilberg.

In regards to the Medicaid expansion, members of the MGMA are divided on whether or not the program was a success, according to Gilberg. "On some level you did insure previously uninsured patients, on another level, the Medicaid programs in many states are paying reimbursement rates at cost and are extremely administratively burdensome to interact with," said Gilberg.

One area the MGMA and AMA are in agreement is that the ACA needed improvements. Barbe echoed Gilberg's thoughts on the high-cost deductibles stemming from the ACA. "The affordability piece was the issue that impacted me most as a practicing physician. And that patient that came in with coverage they purchased on an exchange through the ACA, may have chosen a bronze plan that has a multi-thousand dollar deductible, sometimes three or four thousand dollars. Therefore they are still responsible for that much of their care," says Barbe.

A week after the GOPs AHCA bill was made public, uncertainty and questions continue to surround its every proposal, with the CBO score doing little to curb critics.  "We're hoping [the administration] engages in a more thoughtful dialogue. If I had to give this a grade at this point, I would give it an incomplete. We're not saying we don’t want to fix the ACA, we're saying lets fix it, but not cause mass disruption to the system while we do that," says Gilberg.