Friday, January 6, 2017

Turning the clock back on health care

A new year is usually a time to look forward to better things.

For health care though, 2017 is looking more and more like it will be a year of turning back.  Assuming, that is, that the GOP-controlled Congress and incoming Trump administration are able to enact their plan to repeal, delay and replace the Affordable Care Act.

Full repeal of the ACA will mean turning back to a time when millions more people were uninsured, and when insurance companies routinely denied coverage or limited benefits to people who were sick. 

It would mean going back to the days when more than 20 percent of Americans were uninsured because they did not qualify for Medicaid and other safety-net programs, and couldn’t afford private insurance, compared to fewer than 10 percent who are without insurance today. 

It would mean going back to the days when women were charged higher premiums than men for no other reason than that they were women.  

It would mean going back to a time when insurers were not required to offer coverage for preventive services, contraception, maternity care, mental health, and many other essential benefits, and if they did offer them, they were often subject to deductibles and co-payments.

It would mean going back to the days when insurance companies were allowed to impose annual and lifetime dollar caps on benefits, which often meant bankruptcy for people with expensive conditions like cancer.

The GOP has already started the process of repealing the ACA, scheduling a vote next week on a budget resolution that instructs congressional committees to come up with legislation to repeal as much of the ACA as they can through a process called budget reconciliation, which can be passed by a simple majority vote, no Democrats needed. The budget resolution would put Congress on the path to repealing the ACA in stages, an approach that has been called “repeal, delay and replace.”  (The New York Times has a good primer on how repeal, delay and replace would play out legislatively). 

While the GOP argues that “repeal, replace and delay” will allow people to keep their current coverage while Congress comes up with a “better” replacement, it isn’t likely to work out that way.  More likely, millions will begin losing coverage as early as later this year, as I argued in my recent Annals commentary, something that even many well-respected conservatives are starting to acknowledge.

Still, the GOP congressional leadership seems committed to rolling back the ACA in stages, disregarding the fact that that only 20 percent of the public supports repeal, delay and replace, the warnings about the chaos it will introduce into insurance markets, and the near-impossibility that the GOP will be able to (eventually) craft a replacement that will cover as many as the ACA, with comparable benefits and consumer protections, that can also win Democratic votes.   This means that at some point, most likely starting a few months from now, and certainly by the time when delayed ACA repeal would actually take place in 2018 or 2019, we will go back to the bad old days, before the ACA became law in 2010, when millions more people were uninsured, and when insurance companies routinely denied coverage or limited benefits to people who were sick. 

It doesn’t have to be this way, though.  ACP is doing everything we can to persuade Congress not to move forward with ACA repeal, delay and replace; all it takes is 3 Republican Senators to say no repeal especially without being offered a viable replacement for consideration.  Here are some of the things we are doing:
  • ACP joined with the American Academy of Pediatrics, American Academy of Family Physicians, American College of Obstetrics and Gynecology, in a letter urging the Senate to vote no on a resolution that would start the process of repealing the ACA.  Collectively, our organizations represent nearly 400,000 physician and medical student members.
  • ACP sent its own letters to the Senate and House of Representatives opposing the repeal resolution.
  • ACP has developed advocacy resources to help make the case against repeal, delay and replace,  including my December 15 blog post on “There must be 50 ways you can lose your health insurance (if Obamacare is repealed);  a fact sheet on the impact of repeal;  a table showing the impact in each state on the number of uninsured, people with pre-existing conditions, and uncompensated care costs;  and an at-a-glance profile of the impact for each state.
  • We sent an urgent alert to the 19,000 ACP members who have volunteered to be an Advocate for Internal Medicine, asking them to call their Senators to urge a no vote on the repeal resolution.
  • Next week, we will be communicating with Congress about the key questions that should be asked of any proposals to amend, improve, or replace the ACA, to ensure that patients are not harmed.  The letter will be posted on ACP Online on Monday.
  • ACP has been using social media to draw attention to our concerns about repeal, delay and replace; you can follow me on Twitter at @bobdohertyACP, the Advocates for Internal Medicine network at @AdvocatesIM, and the ACP Public Affairs department @ACPInternists.

The encouraging news is that our concerns are being widely reported by the press and not just through social media, including an opinion piece by New York Times columnist Nicolas Kristof, the Los Angeles Times (same story also published in The Chicago Tribune, San Diego Union-TribuneOrlando SentinelBaltimore Sun and Charlotte Observer), Forbes, Politico, Washington Examiner, and the Providence Journal.

But ACP won’t be successful in stemming the drive to repeal the ACA unless thousands of physicians raise their voices directly with members of Congress.  The Senate is expected to vote on the resolution to start ACA repeal next Wednesday, January 18. We need every doctor who does not want to see nearly 60 million people lose coverage to call your Senators, 202-224-3121, between today and Wednesday to urge them to vote against repeal.

If you don’t act, Congress may very well take us back to the pre-ACA days, when millions more were uninsured and insurers routinely denied coverage or limited benefits for sick people.  We must not let that happen.

Today’s question:  have you called your Senators to urge them to vote against ACA repeal?

1 comment :

Unknown said...

Hi Bob.
Thank you for the post "There must be 50 ways to leave your health insurance." One at a time I am using items on the list as talking points when I email my Senators during the week. I've learned a lot and I hope that the message is getting through to my Senators as well - that is is a very complicated issue that affects the health of millions of Americans.
Jennifer Hagen, MD, FACP