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Doctors, Hospitals Say Latest Trumpcare Version A Bigger Disaster

The latest version of the Trumpcare, has medical care providers mobilizing once again to derail what they say is an even worse version

 By Bruce Japsen  / Forbes, Contributor / April 28, 2017 – I write about healthcare business and policy.  Opinions expressed by Forbes Contributors are their own


The latest version of the American Health Care Act, also known as Trumpcare, has providers of medical care mobilizing once again to derail what they say is an even worse version than what U.S. House Speaker Paul Ryan wouldn’t bring to a vote last month.

An amendment to the AHCA negotiated by the House Freedom Caucus proposes to reduce costs of individual health policies by allowing states to opt out of certain requirements under the Affordable Care Act, also known as Obamacare. States could opt of requiring health plans to provide the so-called “essential health benefits” under the ACA that include everything from hospitalization and mental health coverage to maternity care.

Providers of medical care say the so-called MacArthur Amendment to AHCA would cause millions of Americans to lose coverage, several groups including the American Medical Association and the American Hospital Association, and AARP, the giant lobby for millions of senior citizens.

“The amendment proposed this week would dramatically worsen the bill,” American Hospital Association CEO Rick Pollacksaid Thursday. “The changes included put consumer protections at greater risk by allowing states to waive the essential health benefit standards, which could leave patients without access to critical health services and increase out-of-pocket spending. This could allow plans to set premium prices based on individual risk for some consumers, which could significantly raise costs for those with preexisting conditions.”

Ryan’s earlier version of the American Health Care Act would cause 24 million Americans to join the ranks of the uninsured by 2026, including 14 million by next year, and most of them are covered by Medicaid for poor Americans, the Congressional Budget Office reported earlier this week. Medical providers complain the newer version might add to the uninsured, but nobody knows for sure because it has yet to be “scored.”

“We are deeply concerned that the AHCA would result in millions of Americans losing their current health insurance coverage,” AMA CEO Dr. James Madara said in a Thursday letter to Speaker Ryan. “The MacArthur Amendment would allow states to apply for waivers from critical consumer protections provided in the ACA, including the age rating ratio of 3 to 1, the requirements that health insurers must cover certain essential health benefits and the ban on health status underwriting. The current ban on health status underwriting protects individuals from being discriminated against by virtue of their medical conditions.”

Medical care providers said the new version of Trumpcare doesn’t strengthen the individual health insurance market by improving coverage and offering adequate benefits.

“The recent amendments to the bill, intended to make it more palatable to those who did not support it initially, are even more disastrous for people who have just gotten healthcare,” said Sister Carol Keehan, Catholic Health Association CEO. “Changing the current rules to undermine essential benefits requirements and protections for people with preexisting conditions, as well as allowing insurers to set annual and lifetime caps on the care they cover, would seriously undermine health security and leave many individuals with substandard protection. Even the proposed state high-risk pools would be an inadequate and underfunded solution to a problem that need not exist in the first place.”

Insurance companies including Anthem ANTM -0.41%, Centene CNC +0.21% and many of the nation’s Blue Cross and Blue Shield plans have said the ACA needs fixes to the individual market and not a wholesale replacement. Before they scaled back participation on public exchanges, Aetna AET -0.01%, Humana HUM -0.31% and UnitedHealth Group UNH +0.14% also complained about necessary forms and greater subsidies for patients in the individual market after they were unable to manage mounting costs of sick patients who signed up for coverage.

Providers say the new version of Trumpcare doesn’t fix problems in the individual market.

“Nothing in the MacArthur amendment remedies the shortcomings of the underlying bill,” the AMA’s Madara said in a letter to Ryan. “The amendment does not offer a clear long-term framework for stabilizing and strengthening the individual health insurance market to ensure that low- and moderate-income patients are able to secure affordable and adequate coverage, nor does it ensure that Medicaid and other critical safety net programs are maintained and adequately funded.”

The GOP has yet to schedule a vote on the latest Trumpcare version, and it’s unclear whether it even has the support of enough Republicans to pass the House. Politico reported Thursday morning that the AHCA “may still be short on votes.”

But lobbies for patients and medical care providers aren’t taking any chances, letting members of Congress know there will be repercussions if they vote for the AHCA.

“We intend to let all 38 million of our members know exactly how their Representative votes on this bill,” AARP Executive Vice President Nancy LeaMond said Wednesday. “Our members care deeply about their healthcare and have told us repeatedly that they want to know where their elected officials stand.”

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