AMA Physicians Reject House ACA Replacement Bill

Andrew W. Gurman, MD Andrew W. Gurman, MD
President
American Medical Association
@AndyGurmanMD

The American Health Care Act (AHCA), released by Congress this week, is intended to repeal and replace the Affordable Care Act (ACA). But as introduced, it does not align with the health reform objectives that the AMA set forth in January to protect patients. While the ACA is imperfect, the current version of the AHCA is not legislation we can support.

The replacement bill, as written, would reverse the coverage gains achieved under the ACA, causing many Americans to lose the health care coverage they have come to depend upon.

In a letter sent today to leaders of the House committees that will mark up the AHCA, AMA CEO and Executive Vice President James L. Madara, MD, wrote that the proposed changes to Medicaid would limit states’ ability to respond to changes in service demands and threaten coverage for people with low incomes. Dr. Madara also noted that the proposed changes in tax credits and subsidies to help patients purchase private health insurance coverage are expected to result in fewer Americans with insurance coverage.

It is unclear the exact impact this bill will have on the number of insured Americans, and review by the nonpartisan Congressional Budget Office is still pending. The ratings and analytics firm S&P Global Ratings has already estimated that as many as 10 million Americans could lose coverage if this bill becomes law, saying that between 2 million and 4 million people could lose the insurance they purchased in the individual health exchanges under the ACA, and between 4 million and 6 million could lose their coverage under Medicaid.

That just won’t do.

We all know that our health system is highly complex, but our core commitment to the patients most in need should be straightforward. As the AMA has previously stated, members of Congress must keep top of mind the potentially life-altering impact their policy decisions will have.

We physicians often see patients at their most vulnerable, from the first time they set eyes on a newborn child to the last time they squeeze a dying loved one’s hand. We don’t want to see any of our patients, now insured, exposed to the financial and medical uncertainties that would come with losing that coverage.

That is, above all, why physicians must be involved in this debate.

Editor’s note: In the coming weeks, a series of AMA Wire® articles will explore policies that form the basis of the AMA’s advocacy on health reform. Read parts one (“Protecting insurance gains is priority No. 1”) and two (“No going back on key market protections”).

Reprinted with permission and as Published by the American Medical Association on AMA Wire at: https://wire.ama-assn.org/ama-news/physicians-reject-house-aca-replacement-bill

Letter re: the AHCA being driven through the US House

Veto Message from the President to the Republiban re: HR3762 ACA Repeal

— by Vickie Rock, Humboldt Democrats

After the 62nd vote to repeal “Obamacare” (the Patient Protection and Affordable Care Act) which has now been upheld by the Supreme Court TWICE, the Republiban members of Congress finally managed to pass HR 3762. Inaptly named, the bill that would have done the exact opposite of its title: “Restoring Americans’ Healthcare Freedom Reconciliation Act of 2015.”  Restoring “Americans'” freedom?  Nope!  More like restoring the freedom for Insurance Corporations to give Americans the short shrift related to any hope of accessing healthcare insurance and thus health care itself.

And just so you know, each and every Nevada Republican in the House of Representatives, Rep. Mark Amodei (CD2), Rep. Joe Heck (CD3), and Rep. Cresant Hardy (CD4) voted FOR passage of HR 3762 (as well as a large number of previous bills) which would not just repeal the Affordable Care Act for millions of Americans who can barely afford health insurance as it is, but would have also revoked any and all funding received by Planned Parenthood by folks who not only can’t afford health insurance, but can’t afford health care either.  Senator Dean Heller also voted FOR passage (repeal) in the Senate in December preceding the vote in the House.

Today, at the stroke of his pen, President Obama showed us exactly HOW important it is that we have a Democratic President in the oval office as he promptly and unceremoniously vetoed their wasted efforts.  Here’s his message back to Congress:

TO THE HOUSE OF REPRESENTATIVES:

I am returning herewith without my approval H.R. 3762, which provides for reconciliation pursuant to section 2002 of the concurrent resolution on the budget for fiscal year 2016, herein referred to as the Reconciliation Act.  This legislation would not only repeal parts of the Affordable Care Act, but would reverse the significant progress we have made in improving health care in America.  The Affordable Care Act includes a set of fairer rules and stronger consumer protections that have made health care coverage more affordable, more attainable, and more patient centered.  And it is working.  About 17.6 million Americans have gained health care coverage as the law’s coverage provisions have taken effect.  The Nation’s uninsured rate now stands at its lowest level ever, and demand for Marketplace coverage during December 2015 was at an all-time high.  Health care costs are lower than expected when the law was passed, and health care quality is higher — with improvements in patient safety saving an estimated 87,000 lives.  Health care has changed for the better, setting this country on a smarter, stronger course. 

The Reconciliation Act would reverse that course.  The Congressional Budget Office estimates that the legislation would increase the number of uninsured Americans by 22 million after 2017.  The Council of Economic Advisers estimates that this reduction in health care coverage could mean, each year, more than 900,000 fewer people getting all their needed care, more than 1.2 million additional people having trouble paying other bills due to higher medical costs, and potentially more than 10,000 additional deaths.  This legislation would cost millions of hard-working middle-class families the security of affordable health coverage they deserve.  Reliable health care coverage  would no longer be a right for everyone:  it would return to being a privilege for a few.

The legislation’s implications extend far beyond those who would become uninsured.  For example, about 150 million Americans with employer-based insurance would be at risk of higher premiums and lower wages.  And it would cause the cost of health coverage for people buying it on their own to skyrocket.  

The Reconciliation Act would also effectively defund Planned Parenthood.  Planned Parenthood uses both Federal and non-federal funds to provide a range of important preventive care and health services, including health screenings, vaccinations, and check-ups to millions of men and women who visit their health centers annually.  Longstanding Federal policy already prohibits the use of Federal funds for abortions, except in cases of rape or incest or when the life of the woman would be endangered.  By eliminating Federal Medicaid funding for a major provider of health care, H.R. 3762 would limit access to health care for men, women, and families across the Nation, and would disproportionately impact low-income individuals.

Republicans in the Congress have attempted to repeal or undermine the Affordable Care Act over 50 times.  Rather than refighting old political battles by once again voting to repeal basic protections that provide security for the middle class, Members of Congress should be working together to grow the economy, strengthen middle-class families, and create new jobs.  Because of the harm this bill would cause to the health and financial security of millions of Americans, it has earned my veto.

The Republiban may have used procedural shenanigans to enable them to pass HR 3762, but to override President Obama’s veto, the Republiban would need a two-thirds affirmative vote on repeal bill.  The don’t have that.  This was all for show for the rabid GOP base heading into the November election.  But more than that, it’s a serious red-flag warning to Democrats that if we don’t overwhelm the polls this November to begin taking back Congress, and instead all the Republiban to hold onto Congress plus, take the White House, you can kiss the American Dream goodbye and buy the coffin as it will truly be dead.

522

New FAQ’s on Birth Control Coverage

birth-control-pillsThis week the Departments of Health and Human Services (HHS), Labor, and Treasury issued frequently asked questions (FAQs) to help insurance companies better understand the scope of coverage that is required (including contraceptive care) under the Affordable Care Act (ACA) and to help people better the ACA and benefit from it as intended.

This guidance follows recent Kaiser Family Foundation  and research that reported variation in how the ACA contraceptive coverage provisions were being interpreted and implemented by health plans.

Some main points of interest:

  • All non-grandfathered plans and insurers must cover, without cost sharing, at least one form of contraception within each of the 18 methods of contraception that the FDA has identified for women.
  • If an item or service is not covered but is determined medically necessary by the woman’s attending provider, there must be an easily accessible process for the woman to get that item or service;
  • If an insurer covers dependent children, recommended preventive services for women (such as preconception and prenatal care) must be covered for the dependent children as well (i.e., not just the parent(s) on the plan); and

Clarifies that insurance companies may still use reasonable medical management techniques within each of the methods of contraception (there are currently 18 identified by the FDA for women). For example, a plan can discourage the use of brand name over generic pharmacy items through cost sharing.

Obamacare Reality Check

— submitted by Rich Dunn, RNDC 2nd Vice Chair

If you’re asked about Obamacare, use it as an opportunity to show how much difference progressive change can make. Open enrollment began one year ago, on October 1st, 2013. The websites had a rocky rollout, but 10.3 million Americans who had no health insurance a year ago now have coverage. Competition has increased – there are now 25% more insurance companies offering policies in the health insurance market. United Healthcare, the market leader, will be offering policies on 25 state exchanges in 2015, double the number in 2014. The system was designed to foster competition, and that is exactly what is starting to happen.

According to the Republicans, the ACA was going to be a government takeover of heathcare. But you wouldn’t know that from how private sector insurers have been doing on the stock market. United Healthcare’s stock is up 16%, Humana’s is up 34%, Aetna’s 22%, Cigna’s 13% and Wellpoint’s a whopping 37%. Some government takeover that turned out to be.

On top of that, 8.2 million seniors have saved over $11.5 billion, money that went right back into the economy. Republicans predicted that Obamacare would send costs through the roof, but between 2010 and 2013 health care costs have only risen at an annual rate of 1.1%, which is the slowest rate of increase of any three year period on record and below the overall rate of inflation.

Hospitals are expected to save $5.7 billion dollars this year alone in uncompensated health care costs. Republicans kept saying that all people without insurance had to do was go to the emergency room, but as usual they never mentioned who was supposed to pick up the tab – the hospital, of course. Thanks to Obamacare, that’s now far less of a problem. Most of that $5.7 billion in hospital savings happened in states like Nevada that opted to expand Medicaid. The 23 Republican states that refused Medicaid expansion are seeing a wave of hospital mergers and closures thanks to the rising cost of uncompensated care.

The next open enrollment period begins on November the 15th, and even though there may be more website glitches, it is bound to go a lot smoother this time around. You may have noticed that the Republicans have stopped talking about repealing Obamacare after more than 50 attempts, and that’s because it’s working. It doesn’t solve the long term cost problem – only healthier lifestyles can do that – but at least fewer Americans will be at needless risk because they can’t afford to see a doctor when they get sick.

And don’t forget that insurance companies can no longer drop you from coverage because you get sick. They can no longer refuse to sell you coverage because of a pre-existing condition. Women can now get free breast cancer screening. The “donut hole” for senior meds is being closed. Children can now stay on their parents’ policies to the age of 26. We’ve also seen the end of lifetime limits to insurance reimbursements.

The rate of uninsured Americans has already dropped from 21% to 16%, which is pretty impressive progress considering the level of Republican obstruction at all levels of government. Had that obstruction not occurred, we would now have more like 20 million newly insured Americans instead of just 10.3 million.

Our friend Mark Amodei supported every single attempt to repeal or delay the implementation of the Affordable Care Act, something voters can’t be reminded of too often. Amodei has been part of the problem from day one, and it’s a little late for him to strike a pose as a bipartisan pragmatist who stays above the fray. It’s time for him to go!

Sen Heller Betrays NV’s Women; Votes to Filibuster Hobby Lobby Fix

Sen. Dean Heller (R-NV) Betrays NV's Women
Sen. Dean Heller
Betrays NV’s Women

When the Supreme Court made the terrible decision to allow corporations like Hobby Lobby to discriminate against women, members of Congress were ready to fight back to defend women’s access to birth control.

Senators Murray, Udall and Boxer quickly introduced a bill to make sure that corporations can’t interfere with employees’ access to health care, including birth control, as provided for by the Affordable Care Act (aka Obamacare) under federal law. Senate Majority Leader Harry Reid fast-tracked the bill, bringing it for a full vote in the Senate today.

Not surprisingly, Republicans, including Nevada’s own Senator Dean Heller,  used the filibuster to block an up-or-down vote on the bill, meaning it will now take 60 votes to pass this bill. Only two Republicans broke from their caucus’s en bloc action — Senators Kirk and Murkowski.

Republicans continue to use the filibuster to shut down sensible legislation, and provide cover for their members who don’t want to go on the record in opposition to things like birth control access for women, common sense gun law reform, or relief for crushing student loan debt.

This week, they used the filibuster to block a legislative remedy for the disastrous Hobby Lobby v. Burwell decision. Outrageously, the five male justices on the Supreme Court ruled that the contraception mandate violated the Religious Freedom Restoration Act. In oral arguments, Chief Justice John Roberts suggested that Congress could exempt the Affordable Care Act from the RFRA as a way of protecting the inclusion of contraception as preventative care in the ACA. The Protect Women’s Health from Corporate Interference Act does exactly that, and would have protected not only women’s access to contraception from employer discrimination, but any employees’ access to any health care provided through the Affordable Care Act.

Tell Senate Republicans to end their filibuster and allow a vote on women’s access to birth control. Click the link below to automatically sign the petition:

Take-Action

Vote #228 held on July 16, 2014, 02:09 PM EDT  on the Motion to Proceed (Motion to Invoke Cloture on the Motion to Proceed to S.2578 )

YEAs —56
Baldwin (D-WI)
Begich (D-AK)
Bennet (D-CO)
Blumenthal (D-CT)
Booker (D-NJ)
Boxer (D-CA)
Brown (D-OH)
Cantwell (D-WA)
Cardin (D-MD)
Carper (D-DE)
Casey (D-PA)
Collins (R-ME)
Coons (D-DE)
Donnelly (D-IN)
Durbin (D-IL)
Feinstein (D-CA)
Franken (D-MN)
Gillibrand (D-NY)
Hagan (D-NC)
Harkin (D-IA)
Heinrich (D-NM)
Heitkamp (D-ND)
Hirono (D-HI)
Johnson (D-SD)
Kaine (D-VA)
King (I-ME)
Kirk (R-IL)
Klobuchar (D-MN)
Landrieu (D-LA)
Leahy (D-VT)
Levin (D-MI)
Manchin (D-WV)
Markey (D-MA)
McCaskill (D-MO)
Menendez (D-NJ)
Merkley (D-OR)
Mikulski (D-MD)
Murkowski (R-AK)
Murphy (D-CT)
Murray (D-WA)
Nelson (D-FL)
Pryor (D-AR)
Reed (D-RI)
Rockefeller (D-WV)
Sanders (I-VT)
Schumer (D-NY)
Shaheen (D-NH)
Stabenow (D-MI)
Tester (D-MT)
Udall (D-CO)
Udall (D-NM)
Walsh (D-MT)
Warner (D-VA)
Warren (D-MA)
Whitehouse (D-RI)
Wyden (D-OR)
NAYs —43
Alexander (R-TN)
Ayotte (R-NH)
Barrasso (R-WY)
Blunt (R-MO)
Boozman (R-AR)
Burr (R-NC)
Chambliss (R-GA)
Coats (R-IN)
Coburn (R-OK)
Cochran (R-MS)
Corker (R-TN)
Cornyn (R-TX)
Crapo (R-ID)
Cruz (R-TX)
Enzi (R-WY)
Fischer (R-NE)
Flake (R-AZ)
Graham (R-SC)
Grassley (R-IA)
Hatch (R-UT)
Heller (R-NV)
Hoeven (R-ND)
Inhofe (R-OK)
Isakson (R-GA)
Johanns (R-NE)
Johnson (R-WI)
Lee (R-UT)
McCain (R-AZ)
McConnell (R-KY)
Moran (R-KS)
Paul (R-KY)
Portman (R-OH)
Reid (D-NV)
Risch (R-ID)
Roberts (R-KS)
Rubio (R-FL)
Scott (R-SC)
Sessions (R-AL)
Shelby (R-AL)
Thune (R-SD)
Toomey (R-PA)
Vitter (R-LA)
Wicker (R-MS)

 

Not Voting – 1
Schatz (D-HI)