ACA Fight: It's Far from Over ACP Officials Say

The American College of Physicians (ACP), working with several other physician organizations, helped defeat the Republicans’ proposed American Health Care Act (AHCA), officials said today. But the group is far from feeling that the Affordable Care Act is secure.

Speaking at a news conference at the ACP Internal Medicine Meeting in San Diego this afternoon, Robert Doherty, (photo) the ACPS’s Senior Vice President of Governmental Affairs and Public Policy said the new concerns are whether the GOP will soon come up with a different bill that would include some of the same provisions the ACP found unacceptable.

“They want to take the [ACHA] bill back and they could make it worse,” Doherty said, explaining that a revised GOP health bill could have fewer guaranteed benefits, more out-of-pocket costs, and fewer requirements for health plans such as guaranteeing coverage for people with prior conditions.

The fate of Medicaid is also an issue, with rollbacks in current federal subsidies for states’ Medicaid expansions at risk.

Another GOP strategy might be to let the ACA “implode” by failing to take action on fronts the ACP said are needed to get insurers to stay in the market and stop premiums from rising.

“By next fall the administration will need to promote ACA signup—particularly of young people,” Doherty said. Without getting healthy people insured under the ACA there will continue to be adverse selection leading insurers to lose money and premiums to rise. The Obama administration spent millions of dollars on promoting the ACA but without such a renewed marketing effort signups could decline, he said.

“The administration is obligated to support the ACA, it’s the law of the land,” he said.

But since the Republicans have vowed to undo it, there are other measures Doherty said he fears.

Those include a more restrictive interpretation of what makes up “essential benefits” as plans are required to offer. Among the benefits he feels are open to cutbacks are maternity care and coverage for contraception. Mental health care and substance abuse treatment may also be threatened.

The ACP’s president, Nitin Damle, MD, MS, a Rhode Island physician, said the defeat of the AHCA “was a big victory for my patients,” and that the ACP is renewing its efforts to pressure Congress to fix some problems with the ACA rather than repealing and replacing it.

The Trump administration’s top health officials, Health and Human Services Secretary Tom Price, MD, and Centers for Medicare and Medicaid Services Adminstrator Seema Verma are likely to keep the parts of the ACA that focus on new “value based” methods of paying physicians, and are likely to go along with the agency’s Center for Innovation, which promotes trial programs aiming to cut costs and improve care, Doherty and Damle agreed.

An area of concern to the ACP is President Trump’s use of executive orders to make sweeping changes, such as his reversal of environmental protection measures aimed at stopping climate change. That strategy may not apply to the ACA Doherty said.

“You can’t roll back regulations and you can’t take the ACA away on a dime,” he noted.

Doherty said the ACP, as a physician organization has influence with Congress. “Physicians carry a high degree of credibility,” he said.