As House lawmakers pushed ahead with a proposed bill that could substantially reduce or eliminate insurance coverage for millions of people and increase costs for both patients and physicians, the AAFP sent a strongly worded letter outlining its criticisms of the measure.
Legislators who support the American Health Care Act(bit.ly) (AHCA) intend it to replace the Patient Protection and Affordable Care Act, but the March 14 letter(5 page PDF) to leaders of the House Budget Committee details important concerns. Notably, the AAFP pointed out the potential for the AHCA to bring major reductions in the number of individuals who have health coverage, increase premiums and interfere with the patient-physician relationship.
"The AHCA, in our opinion, prioritizes the elimination of coverage and premium support while failing to address the real-life economic challenges Americans have with health care," the AAFP said in the letter, which was signed by Board Chair Wanda Filer, M.D., M.B.A., of York, Pa.
A review by the nonpartisan Congressional Budget Office(www.cbo.gov) (CBO) found that if the proposed bill is enacted as written, 21 million fewer Americans would have health care coverage in 2020, a figure that would rise to 24 million in 2026. Seven million people who currently have insurance through their employer would lose that coverage.
- The AAFP sent a strongly worded letter outlining its criticisms of the American Health Care Act to leaders of the House Budget Committee on March 14.
- A review by the nonpartisan Congressional Budget Office found that if the proposed bill is enacted as written, 21 million fewer Americans would have health care coverage in 2020, a figure that will rise to 24 million in 2026.
- The AAFP wrote that the proposal does not address the cost of care, and it does not support a continuous physician-patient relationship or the recent gains made in expanding access to care for low-income individuals.
"Our concerns are primarily focused on the significant loss of health care coverage that will be experienced by millions of Americans should this legislation become law," the letter stated. "Furthermore, we believe those who retain coverage will face escalating premiums and deductibles that will further separate them and their health care needs from the health care system."
The legislation has been moving quickly through committees without significant changes and appears headed to a vote on the House floor soon.
As written, it does not address the cost of care, and it does not support a continuous physician-patient relationship or the recent gains made in expanding access to care for low-income individuals. The CBO estimated that it could increase health insurance premiums for individuals by 15 percent to 25 percent.
One change the AAFP said legislators could make to support primary care, improve health outcomes and lower costs would be to require insurers to consider all primary care physicians to be "in network." This would encourage continuous physician-patient relationships.
"The AHCA, in its current form, does not include a single provision that would facilitate greater connection between individuals and a primary care physician," the letter stated.
An emphasis on primary care and prevention would keep patients from relying on more expensive acute care, and the AAFP told legislators just how expensive that acute care is. Whereas the average cost of a primary care physician visit is $160, the median charge for ER outpatient care is $1,233, and the average hospital stay is $10,000.
"A patient could see a primary care physician 7.7 times for the cost of a single visit to the emergency room and 62.5 times for a single hospital admission," the letter noted.
The proposed bill would reduce federal Medicaid spending and limit its growth starting in 2020. More than 70 million people now rely on Medicaid for medical coverage, and 68 percent of family physicians report accepting new Medicaid patients in their practices, the highest rate of participation since the AAFP began monitoring the issue in 2004.
"In our opinion, the AHCA would take steps backward from meeting these standards," the letter stated. "In fact, the sudden elimination of coverage for millions of currently eligible beneficiaries, coupled with the proposed financing mechanism that cuts federal funding, would essentially create a race to the bottom among the states in the name of flexibility."
Other provisions in the proposed bill would eliminate many milestones that have been achieved in expanding access to care for individuals who need it. For instance, the proposal would eliminate federal guarantees to access to mental health care and addiction treatment for Medicaid beneficiaries in states that expanded Medicaid.
"At a time when many states are facing a crippling public health crisis resulting from widespread opioid and heroin addiction, reducing access to mental health and addiction services is inappropriate," said the letter.
The proposed prohibition of Medicaid payment for some health care professionals and facilities means millions of women would lose access to essential health care. Congress would be using the power of federal funding to determine what kinds of care are appropriate for a physician to provide to a patient, which the AAFP called an inappropriate intrusion into the physician-patient relationship.
Supporters of the AHCA insist -- even though the CBO has determined otherwise -- that the new bill would provide every American with access to coverage, a position the AAFP countered fiercely.
"'Access to health care coverage' is distinctly different than 'securing health care coverage,'" the letter stated. "The AAFP's goal is to ensure that every American 'secures health care coverage.'"
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