Opposition Voiced Against Republican-led Healthcare Reform

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The AMA and ACP voice their concern with the new American Health Care Act.
The AMA and ACP voice their concern with the new American Health Care Act.

Two of the nation's preeminent medical associations have spoken out in opposition to the Republican-led healthcare reform bill designed to replace Obamacare. Both the American Medical Association and the American College of Physicians (ACP) sent letters to Congressional leadership yesterday voicing a lack of support for the newly introduced American Health Care Act (AHCA).

A letter to House leadership from James L. Madara, MD, the AMA's executive vice president and CEO, acknowledged there are issues to be addressed resulting from the Affordable Care Act (ACA) but asserted that his organization's primary goal is to ensure that the millions who gained coverage under the ACA maintain that coverage if subsequent legislation were to replace the Obamacare bill.1,2

“While we agree that there are problems with the ACA that must be addressed, we cannot support the AHCA as drafted because of the expected decline in health insurance coverage and the potential harm it would cause to vulnerable patient populations,” Dr Madara declared.

“I am writing to express our strong opposition to the American Health Care Act (AHCA),” noted Nitin S. Damle, MD, FACP, president of the ACP, in separate letter to Congress.3,4 

“While we have long advocated for improvements to the [ACA],” Dr Damle added, “this bill would go in the wrong direction, by repealing many essential provisions of the ACA and substituting policies that would rollback coverage and consumer protections for many millions of Americans, including radical changes in how Medicaid is financed.”

Andrew W. Gurman, president, AMA

  • "While the ACA is imperfect, the current version of the AHCA is not legislation we can support.

    The replacement bill, as written, would reverse the coverage gains achieved under the ACA, causing many Americans to lose the health care coverage they have come to depend upon." -- from AMA Wire

Rather than expanding Medicare or providing subsidies to those purchasing insurance plans, the AHCA would provide tax incentives to purchase healthcare coverage. The GOP-backed bill would eliminate the individual insurance mandate but would preserve safeguards on pre-existing conditions and still allow parents to carry children on their health insurance policies up to the age of 26.

The proposed bill would also allow insurance providers to charge penalties to those with pre-existing conditions who allow their policies to lapse and are not continuously covered.

Medicaid expansion to cover low-income Americans would continue under the new bill, but the Obamacare plan that provided states with additional funds to enroll more Medicaid recipients would lose its funding from the federal government in 2020.

The ACP's letter highlighted age-based tax credits as a replacement for income-based subsidies in particular, predicting that the practice would make coverage more expensive for the sick, elderly, and poor. “This bill will result in many millions of Americans losing coverage, benefits, and consumer protections,” Dr Damle advised.

The AMA, on the other hand, said it has supported the use of “advanceable, refundable tax credits” as the AHCA's preferred method to expand healthcare coverage and make it more affordable for individuals to purchase private insurance policies. Dr Madara took issue, however, with AHCA's proposed use of age-related tax incentives.

“We believe that credits should be inversely related to an individual's income,” he wrote. “This structure provides the greatest chance that those of the least means are able to purchase coverage. We believe credits inversely related to income, rather than age as proposed in the committee's legislation, not only result in greater numbers of people insured but are a more efficient use of tax-payer resources.”

References

  1. AMA says American Health Care Act is critically flawed [press release]. Chicago, IL: American Medical Association. Published March 8, 2017. Accessed March 8, 2017.
  2. American Medical Association. AMA Letter on AHCA 3-8-17. https://www.ama-assn.org/sites/default/files/media-browser/public/washington/ama-letter-on-ahca.pdf. Published March 7, 2017. Accessed March 8, 2017.
  3. Internists say the American Health Care Act will negatively impact patients and reverse coverage gains from the ACA [press release]. Philadelphia, PA: American College of Physicians. Published March 7, 2017. Accessed March 7, 2017. 
  4. American College of Physicians. Letter to Congressional Leaders Opposing American Healthcare Act of 2017. Published March 7, 2017. Accessed March 7, 2017.
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