Last week, Speaker of the House, Paul Ryan, and President Donald Trump decided to pull a proposed bill that would have repealed and replaced certain elements of the Affordable Care Act (ACA).
The bill, the American Health Care Act (AHCA), didn't have enough support in the House to pass a vote on the floor. It would have replaced the subsidies that the ACA provided for low-and-middle-income families with a tax credit, ended the Medicaid expansion program in 2020, and increased the amount insurers can charge older consumers compared to younger ones from three times the amount to five times.
On top of not having enough support in the House, the bill didn't enjoy much popularity outside of politicians. It had a 17 percent approval rating, according to one poll and many medical advocacy groups came out and denounced it. One such group was the AMA, whose president-elect, David Barbe, practicing family physician in Mountain Grove, Mo. called the proposed bill a "step backwards" in an interview with Physicians Practice.
Now that the bill has been pulled, we spoke again with Dr. Barbe on health policy. This time we looked at the lessons to be learned from the AHCA failing, how the ACA can be improved, and how physicians should move forward during this uncertain time.
The following are excerpts from our conversation.
What is the lesson of the AHCA failing?
Listen to those who are most experienced in delivering healthcare and who are closest to the patients. I don't think our perspective on the cautions we raised were given enough credence. Our voice was not alone. We were joined by others on the provider side.
Where does Congress go from here now that the AHCA has been pulled?
I think [any legislation] needs to [include input] from [doctors] and patients. It needs to be bipartisan. If there were criticisms related to the ACA, it was on how it passed in the first place. If we could avoid this kind of situation, the odds are good we'll have a better bill and broader support.
What specific improvements would the AMA like to see to the ACA?
One of the concerns that we've had most recently is the ability to afford the premiums. We need to continue to look at how we structure the tax credits. One of [the AMAs] most serious concerns about the AHCA is that it looked like the tax credit structure was going to change significantly and make it even more difficult for people to afford the premiums. Affordable premiums is one thing. Second, affordability of the benefit design. We're concerned that the high deductibles in some of lower tiered plans, like the bronze plan, are so high that [patients] can't use them. It's essentially self-pay except for catastrophic care.
Another improvement is fixing the "family glitch." It's an oversight in the ACA where family members and children are ineligible to receive tax credits in certain situations, specifically when the primary person in the household is employed but the employer doesn't offer affordable coverage. That needs to be fixed.