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Health Care Bill Passed by House Seen as Harmful and Flawed by ACP

College objects to changes it says would hurt patients with pre-existing conditions and eliminate essential benefits

May 5, 2017 (ACP) -- The American Health Care Act -- passed May 4 by the U.S. House of Representatives as a replacement for the Affordable Care Act -- is "inherently flawed and harmful" to patients, physicians and health care in general, the American College of Physicians stated in response to the congressional action.

Dr. Jack Ende, ACP's president, said the College is "extremely disappointed" that the House passed legislation that "makes coverage unaffordable for people with pre-existing conditions, allows insurers to opt-out of covering essential benefits like cancer screening, mental health, and maternity care and cuts and caps the federal contribution to Medicaid while sun-setting Medicaid expansion."

"As a result, an estimated 24 million Americans will lose their coverage, and many more will be at risk of paying higher premiums and deductibles," Ende said.

In a letter to Senate leaders sent after the House passed the bill by a 217 to 213 vote, ACP said that the legislation in its current form would "erode coverage and essential consumer protections for the most vulnerable patients: those who are older, sicker and poorer." The College asked that senators reject the House version of the bill and "instead work with us to achieve real bipartisan solutions to improve access, coverage and consumer protections for all Americans."

House Republicans were able to generate enough support to get the legislation passed primarily by tweaking provisions related to pre-existing conditions. For weeks, GOP holdouts had maintained that the bill did not adequately protect such patients, but a last-minute amendment that added funding -- $8 billion over five years -- to help people with pre-existing conditions afford their insurance premiums apparently swayed enough House members to vote yes.

However, ACP believes that people with pre-existing conditions remain at risk.

"While the AHCA attempts to cover individuals with pre-existing conditions through high-risk pools or reinsurance programs, the pre-ACA experience with high-risk pools is that they do not provide adequate coverage and protection," the College noted in its letter to the Senate. The funding allocated in the amendment that led to passage of the bill is a "paltry increase [that] will not make coverage affordable for sick people," ACP wrote.

The College noted that "a recent analysis found that the AHCA, prior to this amendment being adopted, would leave a $20 billion annual shortfall in the amount of funding that would be needed for such pools to be sustainable. The amendment's addition of an average of $1.6 billion per year doesn't come close to providing the resources needed."

"Simply put, high-risk pools are no substitute for maintaining the ACA's prohibition on insurers charging more to people with pre-existing conditions," ACP wrote.

In addition to the issue of pre-existing conditions, ACP wants the Senate to fix other provisions that the College also finds egregious.

The legislation "would make radical changes to the Medicaid program's structure and financing, resulting in the rollback of coverage for many millions of the most vulnerable Americans," ACP told Senate leaders. "Specifically, we oppose capping, block granting and cutting the federal contribution to Medicaid, ending federal funding for Medicaid expansion and eliminating the requirement that Medicaid cover essential health benefits."

"The AHCA would dramatically transform the Medicaid program in a way that would severely undermine, underfund and jeopardize continued coverage for tens of millions of enrollees," ACP wrote in its letter to the Senate.

The College also objects to the replacement of income-based premium and cost-sharing subsidies with age-based tax credits. These "result in higher premiums and deductibles for millions of patients, with persons aged 50 and over being most at risk of having to pay thousands of dollars more out-of-pocket," ACP wrote. "For many of them, insurance would simply become unaffordable."

Another revision that helped resurrect the bill, after it failed to garner enough support to get it to a vote in late March, was the creation of a waiver process by which states could opt out of several mandates of the Affordable Care Act. As passed, the legislation would allow states to waive the ACA requirement that all insurance plans cover certain so-called essential health benefits. Under the ACA, these include preventive care visits, screenings and vaccinations, maternity care, prescription drug coverage and mental health treatment as well as outpatient care, emergency services and hospitalization.

The change could make such coverage dependent on where a patient lives.

ACP would like the Senate to change this provision of the bill as well.

Overall, "these harmful changes would return the country to the pre-Affordable Care Act days when persons with pre-existing 'declinable' medical conditions in most states were priced out of the market and the insurance products available in the individual market did not cover medically-necessary services," Ende said.

ACP had advocated strenuously against passage of the AHCA by the House and plans to continue doing so as the bill now moves to the Senate.

"The House action is by no means the end of the story," Ende said. "ACP will continue to do all that it can to ensure continued coverage and access for the millions of patients who have benefited from the Affordable Care Act."

As ACP told Senate leaders, "the College strongly believes in the 'first, do no harm' principle," urging the senators to "move away from the fundamentally flawed and harmful policies that would result from the American Health Care Act as passed by the House and ... reject this legislation."

Instead, ACP urged in its letter, work with the College to "help make health care better, more accessible, and more affordable for patients rather than imposing great harm on them as the AHCA would do."

More Information

ACP's letter to Senate leaders on the AHCA is available on the College's website.

The College's statement on the House vote on the AHCA also is on the website.

The official vote tally can be accessed on the House of Representatives website.

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