Friday, June 23, 2017

Heartless and Harmful

President Trump told a group of Republican Senators that the House-based American Health Care Act is “mean”—and on this he surely called it right! How else would one describe a bill that would take health insurance away from 23 million people, allow states to waive rules requiring insurers to cover people with preexisting conditions at no extra charge, and raise premiums and deductibles to the oldest and sickest patients.  He reportedly urged the Senate to come up with a bill that has more “heart.”

Well, if that was his pitch, the draft bill released yesterday by Majority Leader Mitch McConnell is anything but.  It’s heartless and harmful to the most vulnerable in America: women, children, the disabled, the elderly, the sick and the poor; to people suffering from opioid addiction; and especially to the more than 70 million Americans who rely on Medicaid for coverage and access to health care.  Yet the President tweeted this morning in favor of the bill.  Go figure. 

In fact, in many respects, the Senate bill, introduced under the Orwellian name “The Better Care Reconciliation Act” (BCRA) of 2017, is meaner and has even less heart than the House bill. It cuts Medicaid by more than the House bill.  It allows states to waive almost all of the protections mandated by the ACA, including coverage for essential benefits (like chemotherapy and treatment for opioid use disorders) and the requirement that insurers spend at least 80 percent of their premiums on patient care services rather than administration and CEO compensation (and it even lifts the $500,000 cap on the amount that an insurer can deduct from taxes for CEO compensation!).  You can read about all of the things that are heartless and harmful in the bill in a letter ACP sent yesterday expressing our strongest possible opposition to it. 

Yet Majority Leader McConnell plans to bring it to a vote next week, before Congress adjourns for an Independence Day recess, even though the bill was developed in secret, with no hearings, no committee “mark-ups,” and with no effort to consider the views of ACP and others who actually know something about how a lack of insurance affects patient care.  We won’t know the Congressional Budget Office’s assessment of what the bill would cost, and how many would lose coverage, until just hours before the bill will be voted on.
 
And make no mistake about it: the bill will pass the Senate unless three Republican Senators have the moral courage to say no to it, and if the Senate passes it, the House almost assuredly will do the same.  Game over.
 
But we can still win this fight, but only if enough of you, the constituents who your Senators are supposed to represent, speak out now about the harm it will do to patients. Today, ACP issued an all-hands-on-deck legislative alert to our Advocates for Internal Medicine, and linked to it in today’s ACP Advocate newsletter sent to all ACP members.  It has simple instructions and a sample script to use in making your calls.  We especially need calls to the following Senators: Susan Collins (ME), Lisa Murkowski (AK), Rob Portman (OH), Dean Heller (NV), Dan Sullivan (AK), Jeff Flake (AZ), Cory Gardner (CO), Bob Corker (TN), Bill Cassidy (LA), and Shelley Moore Capito (WV).

Next Wednesday, which may very well be the day before the bill will be voted on in the Senate, ACP’s President will fly to Washington to join with his counterparts with the American Academy of Family Physicians, American Academy of Pediatrics, American Congress of Obstetrics and Gynecology, American Psychiatric Association, and American Osteopathic Association to deliver personalized letter to all 100 U.S. Senators urging a NO vote on the bill, on behalf of the 560,000 physician and medical student members collectively represented by our organizations, and their millions of patients.  (Read the coalition’s statement on the Senate bill issued yesterday).
 
We are doing everything in our power to stop the Senate’s heartless and harmful bill from becoming law.  Please help us, and more importantly your patients, by calling your Senators now, 202-261-4530.

Today’s question: what have you done to stop the Senate bill?

3 comments :

Harrison Robinson said...

The problem that the Republicans have is that Obamacare without a public option is Republican legislation. Like it or not, the Democrats bent over backwards to get Republican Senators on their side. When it became clear that the number one legislative priority for Republicans in 2009 and 2010 was to oppose any and all Obama initiatives, they all were required to vote against it. The alternative was to lose standing in their party and to lose committee memberships and campaign funding and perhaps even to face a conservative primary election challenger.
So now the conservatives have to move even further to the right.

And they have to do so with a President who wants only a legislative trophy with tax cut provisions.
And I'm not sure that the person who holds the office is even knowledgeable enough of the issue to make a coherent statement accurately about anything either in the legislation or that he would want to see in the legislation.

It is hard to convince Senators to take votes that put their political futures in jeopardy when you do not even know what principle you want them to stand for.

There are things that need fixing.
Premiums are too high.
Deductibles are too high.
Costs in general hurt access to care.
And incentives for providers to offer needed care and to make the practice of medicine feel like a partnership with our patients are somewhat lacking -- I lost over $40,000 in incentive payments because I couldn't get more than 85% of women ages 50 to 75 to do scheduled mammograms, or 80% of patients to do colon cancer screening, or 40% of my diabetics to meet all four of the following: 2 A1c's in the calendar year, most recent A1c below 8%, complete urine for microalbumin, and do a dilated eye exam.
All of it is harder than you think.

To push for this stuff you almost feel like a patient's adversary rather than a partner.

Although, I'm not sure about alternatives.

Neither are the Republicans.
I think we should just keep on working to improve the system we have.

Harrison

Harrison Robinson said...

The problem that the Republicans have is that Obamacare without a public option is Republican legislation. Like it or not, the Democrats bent over backwards to get Republican Senators on their side. When it became clear that the number one legislative priority for Republicans in 2009 and 2010 was to oppose any and all Obama initiatives, they all were required to vote against it. The alternative was to lose standing in their party and to lose committee memberships and campaign funding and perhaps even to face a conservative primary election challenger.
So now the conservatives have to move even further to the right.

And they have to do so with a President who wants only a legislative trophy with tax cut provisions.
And I'm not sure that the person who holds the office is even knowledgeable enough of the issue to make a coherent statement accurately about anything either in the legislation or that he would want to see in the legislation.

It is hard to convince Senators to take votes that put their political futures in jeopardy when you do not even know what principle you want them to stand for.

There are things that need fixing.
Premiums are too high.
Deductibles are too high.
Costs in general hurt access to care.
And incentives for providers to offer needed care and to make the practice of medicine feel like a partnership with our patients are somewhat lacking -- I lost over $40,000 in incentive payments because I couldn't get more than 85% of women ages 50 to 75 to do scheduled mammograms, or 80% of patients to do colon cancer screening, or 40% of my diabetics to meet all four of the following: 2 A1c's in the calendar year, most recent A1c below 8%, complete urine for microalbumin, and do a dilated eye exam.
All of it is harder than you think.

To push for this stuff you almost feel like a patient's adversary rather than a partner.

Although, I'm not sure about alternatives.

Neither are the Republicans.
I think we should just keep on working to improve the system we have.

Harrison

Frank said...

It is not clear to me that we are employing our full resources as medical organizations to advocate for our patients. As has been highlighted by many others, members of Congress are subject to immense political pressures and often make decisions despite calls in opposition from their constituents. This is amplified if the representatives in Congress from your state have already adopted a position either against or in favor of our perspective. This may cause us to think that we (as individuals) are without significant influence in other areas of the country where collective voices could sway the vote in favor of the patients for whom we are trying to advocate.

I would strongly suggest that organizations such as ACP utilize similar political and economic forces as those working against making affordable healthcare available to everyone. We can exert that influence in key areas of the country where a single vote in the Senate could accomplish our stated goals of defeating proposed legislation that injures access to healthcare.

ACP should exert that stance by notifying Senators and Governors from states such as Nevada that ACP will no longer consider having any annual session or conference of any type in Las Vegas if they support legislation that limits access to healthcare for our patients. This was partially successful in Carolina when they passed the "bathroom bill" and forced members of their legislature to reconsider their stance when faced with the withdrawal of income to their state.

This may seem like a small step but it allows me to collectively but appropriately exert influence beyond calling my Senators who have both already expressed stated positions against the current Senate bill. It is my experience that money always trumps phone calls and emails that are screened by office assistants and often are not even seen by the legislator until after the issue has been addressed by a vote on the Senate floor.

Frank Green
Kennebunkport, ME