On June 27th, after weeks of discussions with a select group of Republican Senators, Majority Leader Mitch McConnell put the vote on the Better Care Reconciliation Act, the bill that would repeal and replace Obamacare (The Affordable Care Act – ACA), off until after the July recess. But that wasn’t the end of it. On July 18th it became clear the GOP could not get the votes to pass the bill, and McConnell announced he wouldn’t bring it to a vote. Immediately after that decision, there was talk of a straightforward repeal vote with no replacement, but more than a few GOP Senators immediately quashed that idea. There are still rumblings, but it appears that a straightforward repeal is unlikely. Senators are hearing from their constituents and it looks as though the ACA has gained enough popularity to make repealing it a very tricky issue for lawmakers. This leaves the healthcare field, and millions of Americans, in uncertain territory. This uncertainty doesn’t appear likely to disappear any time soon. The Republicans speak of their commitment to repeal the ACA: Their Senate Bill gave us some indications of what they’d like to see eliminated and what that would mean for healthcare. With the tumult of the past month or so, it looks as though uncertainty about healthcare will continue until Congress can get a bipartisan plan together.
What the American Medical Association Thinks
The AMA came out hard against the GOP Better Care Reconciliation Act, the Senate’s bill attempting to repeal and replace the ACA. AMA’s CEO James Madara sent a letter to Senate Majority Leader Mitch McConnell saying” “Medicine has long operated under the precept of Primum non nocere, or ‘first, do no harm.’ The draft legislation violates that standard on many levels.” The issues the AMA has with this Better Care Reconciliation Act are as follows:
- The CBO predicts that millions of Americans will lose their health coverage and be unable to afford medical care.
- “…a combination of smaller subsidies resulting from lower benchmarks and the increased likelihood of waivers of important protections such as required benefits, actuarial value standards, and out of pocket spending limits will expose low and middle income patients to higher costs and greater difficulty in affording care.”
- Drastic cuts to Medicaid.
- Tax credits for private health insurance that exist under the ACA will be available to fewer people, and they’re have higher deductibles.
- States would be allowed to make broad changes to their insurance market, allowing insurers to create weak plans.
The AMA is not alone in their rejection of the bill; many healthcare organizations, including the New England Journal of Medicine, came out loudly against the bill. Of course, all of that vocal activism won’t mean anything if the Better Care Reconciliation Act goes through.
What If The ACA Is Repealed?
How are physicians to deal with this uncertainty considering that their careers and daily lives are profoundly impacted by changes politicians may or may not make in the healthcare system? The reality is what all physicians already know: they have no control over how medical care is paid for. It is clear that organizations representing physicians are opposed to the Senate bill because it will leave so many people uninsured, especially as the mandate for individuals to carry health insurance would be removed. Without insurance, physicians will have no way to bill for many preventive services or screening for serious illnesses. People may avoid treatment until it is absolutely essential. The way it appears now is that those covered by employer provided, private insurance won’t change much. The Senate bill keeps subsidies for private insurance, but with less funding. If it were passed, younger, healthier patients will pay less under the Better Care Reconciliation Act, but the elderly and the poor will find themselves paying even higher premiums. Right now, the healthcare industry can only engage with politicians and try to have their voices heard. Individual physicians should, at a minimum, stay abreast of the political discussions and prepare for even more upheaval if the bill passes. We’ll continue to make updates from the perspective of healthcare professionals, so stay tuned to this blog. And let’s just hope that politicians are listening to those who work in the field every day.