Family physicians need to be actively engaged in advocacy now, while senators are considering major health care legislation, two health policy analysts said during the 2017 Family Medicine Advocacy Summit held here May 22-23.
"We are struggling with one of the most important social justice issues of our time," Families USA Executive Director Frederick Isasi tells an audience of family physicians during the 2017 Family Medicine Advocacy Summit, referring to congressional efforts to reshape current health care policy.
To give physicians different perspectives of deliberations regarding the American Health Care Act (AHCA), Galen Institute President Grace-Marie Turner and Families USA Executive Director Frederick Isasi each spoke during the event about pending Senate action.
Senate Majority Leader Mitch McConnell, R-Ky., has indicated he wants the Senate to pass its version of health care legislation by July 4. Whatever final legislative product emerges, several trends will make it difficult to maintain the same level of health insurance coverage with the deep cuts to Medicaid called for in the AHCA, which the House passed on May 4.
"We are struggling with one of the most important social justice issues of our time," said Isasi, who contended that states will not be able to make up for the AHCA's proposed federal funding cuts.
Turner highlighted a different problem, saying the cost of insurance is high because too many young, healthy individuals -- many of whom face student loans and other big expenses -- are not buying policies despite the mandate to do so.
"People learned they can game the system and wait until they get sick, then drop their coverage after receiving treatment or surgery," Turner said. "It's created a sickness fund instead of a health care fund."
"Congress understands that millions will lose coverage if they don't act," says Grace-Marie Turner, president of the Galen Institute, during the summit. "There is an urgency to act to help people."
In addition, a lack of insurance competition is affecting individuals with employer-sponsored coverage, 30 percent of whom have no choice of available plan. Nationwide, 70 percent of all counties will have only one or two insurers, according to Turner, and some areas would be even worse off. A prime example is Iowa, where cuts under the AHCA would leave 94 of the state's 99 counties with no insurer. The legislation also would leave the 19 states that have not expanded Medicaid unable to do so.
"Congress understands that millions will lose coverage if they don't act," Turner said. "There is an urgency to act to help people."
Isasi talked about the effects of the AHCA's proposed cuts to Medicaid, a program that covers 40 percent of children in the United States. The bill would cut $800 billion from Medicaid and substantially reduce subsidies for health insurance coverage. As a result, he said, premiums would increase by $13,000 for a 64-year-old Medicaid beneficiary who earns $27,000 annually.
Some legislators have suggested that states should play a greater financial role, but few have the resources to do so, Isasi said.
"States do not have the money to fill in for the lack of federal funding," he said. "It took them much longer to recover from the recession."
Isasi noted that most senior senators have indicated in discussions that they think the poorest individuals could obtain coverage through Medicaid, but he said income requirements in states that did not expand the program limit eligibility.
He urged attendees to build relationships with their state budget directors. These officials are typically among the top three most influential members of a governor's cabinet and usually understand the financial impact of deep federal cuts, he said.
Isasi asked physicians to send the message that health care legislation should not take away gains that have already been achieved.
"Do not cut or destroy Medicaid by cutting the safety net program," Isasi said. "Moving Medicaid to a per capita cap means that every time Congress wants to balance the budget, they will turn the dial.
"It is a nuclear missile pointed at the states."