Progress Notes features doctors and medical students across the country on the frontlines of our health care system. Our views and experiences are diverse, but we share common goals and values. We speak up to move toward a future where everyone can have access to affordable, high-quality health care. Please share our posts, and follow us on Facebook and Twitter!
"We're going to be living with Obamacare for the foreseeable future" -- Speaker Ryan
We did it.
Tomorrow, on the seventh anniversary of the Affordable Care Act, the House of Representatives will vote on an ACA repeal bill that would take away healthcare from 24 millions patients, make disastrous cuts to Medicaid and strip away consumer protections.
Now is the time to urge your member of Congress to oppose this bill, which hurts patients. Members of the House are divided about the bill and that gives us an opening. We must make certain Congress hears from doctors and medical students right now about our opposition to this bad bill.
Action Alert: Call your member of Congress at 202-224-3121.
This is the time to stand up and speak out for the progress we have made together over the last seven years in getting America covered. We must not go backward.
Scott Poppen, MD MPA
Doctors for America
- Register for the 2017 National Leadership Conference and book your hotel room before the April 6th cut-off date to recieve the room block rate.
- The Congressional Budget Office (CBO) says 24 million patients will become uninsured if the GOP repeal bill passes. That's unacceptable. The House plans to vote on the repeal bill on THURSDAY March 23rd -- the 7th anniversary of the signing of the ACA. Let's make our voices heard at this critical moment!
- Call your member of Congress at 202-224-3121 and tell them doctors and medical students urge them to vote no.
- Then make your voice heard on social media. Sample Twitter and Facebook posts are below.
- Sample Tweets:
All major hospitals are united against Congress' new health care bill because it fails patients across the US. #ThisIsntCare
Those who know our health care system the best are united against Congress’ proposed replacement bill. #ProtectOurCare
The new health care bill will worsen opioid crisis. Fewer people will have access to addiction treatment and mental health care. #ThisIsntCare
- Sample Facebook Post:
The people who know our health care system the best are united against Congress’ proposed health care bill because they know it will fail millions of patients. Call Congress now: 202-224-3121.
Mental health and addiction services are absolutely critical for those battling addiction. By defunding Medicaid, Congress’ new health care bill all but ensures that America’s opioid crisis will worsen. Call Congress now: 202-224-3121.
- Sample Tweets:
- Call your member of Congress at 202-224-3121 and tell them doctors and medical students urge them to vote no.
The Congressional Budget Office scoring of the American Health Care Act (AHCA) drew largely negative responses from the left and also from the right, who have long struggled to unite around a single replacement plan for the Affordable Care Act (ACA). The CBO is a non-partisan government agency, led by a director who was appointment by GOP leaders in 2015. Some key highlights from the CBO report include 14 million fewer Medicaid enrollees by 2026, 24 million more people without insurance over a decade, $337 billion reduction in deficit over the next decade, a 15% - 20% increase in 2018 premiums, and a $880 billion drop in federal Medicaid spending over the decade. Even prior to the CBO report, there have been numerous studies examining the impact of the ACHA on coverage levels, affordability and state costs, including an issue brief from the Kaiser Family Foundation examining how health insurance tax credits are reduced under AHCA in comparison to the ACA, and a Commonwealth Fund report on high-risk pools which are a central feature of the Republican replacement plan.
AHCA has advanced through the House Ways and Means and Energy Committees, and just yesterday was narrowly approved by the House Budget Committee to repeal and partially replace Obamacare. The vote reinforced GOP divisions over the legislation with three GOP defections from members of the House Freedom Caucus. House Speaker Paul Ryan has conceded that changes will have to be made to the House bill, in light of these lingering GOP divisions as well as the CBO analysis. Among potential changes are considerations to drop a provision requiring insurers to charge a 30 percent penalty for people who do not have continuous coverage, as well as changes in age-based tax credits and the freeze date for enrollment in Medicaid expansion states.
President Donald Trump and Vice President Mike Pence have been meeting with lawmakers and holding rallies across the country to address concerns and encourage support for the replacement plan. Department of Health and Human Services Secretary Tom Price has been communicating the same message, most recently in a town hall this past Wednesdayduring which he fiercely defended the American Health Care Act. However, challenges to the proposed bill pervade the broader stakeholder landscape, as numerous industry and hospital associations have spoken out against various provisions. Critics include the American Medical Association, American Hospital Association, AARP and the American Academy of Family Physicians. Opponents also include conservative groups, right-wing media and Republican lawmakers. Health insurer Anthem, Inc. had also sought changes to the Republican replacement plan for the ACA, stating interest in maintaining cost-sharing subsidies.
And just as the Republican health care bill is expected to make sweeping changes to the Centers for Medicare and Medicaid, the Senate confirmed Seema Verma as the new Centers for Medicare and Medicaid Administrator in a 55-43. On her first day in office, she issued a joint letter with Secretary Price to governors, affirming the partnership between HHS, CMS and States to improve the Medicaid program. The letter outlines intent to increase employment among Medicaid beneficiaries and to have states lead a number of reforms to align Medicaid and private insurance policies for non-disabled adults.
WHAT THE CBO SAID
The bill would lower federal deficits by $337B over 10 years, largely as a result of cuts to Medicaid.
Read the CBO projections on the impact of the Republican American Health Care Act here.
The CBO projects that the AHCA would result in 24M Americans losing their health insurance, and rising premiums for those covered on the individual market.
- The cost of the bill is estimated at $900B (55% less than the ACA).
- Medicaid expansion enacted by the ACA would be rolled back by 2020; overall Medicaid spending cut by $880B; by 2026, federal Medicaid spending would be 25% lower under the house bill than is projected under the current law, and the number of Medicaid beneficiaries would be 17% lower (14M fewer people on Medicaid).
- Average premiums in the individual market would rise by as much as 20% in 2018 and 2019 before falling in 2020 (for an overall drop of 10% on average).
- The total number of uninsured would grow by 24M over the next decade, resulting in a total of 52M uninsured Americans in 2026; if the bill is implemented soon, it is estimated that approximately 14M will be uninsured, largely due to the repeal of the individual mandate.
- The plan would allow insurers to sell health plans covering a smaller share of medical costs and cost-sharing subsidies would be repealed for low-income individuals starting in 202; out-of-pocket costs would be higher.
- The repeal bill primarily deals with individual and Medicaid segments; however, estimates that employer coverage would drop by 7M over the next decade.
MEMBERS IN ACTION
Over 100 doctors and medical students have submitted letters to the editor opposing the House Republican ACA Repeal Bill because it would hurt patients. Make sure to send us a link to your published LTE. EmailDFAHQ@drsforamerica.org.
DFA Statement on the CBO Score of the American Health Care Act. Read full statement here.
"In medicine, we triage. That means we strive to make sure that those who need help the most get it first. The American Health Care Act does the opposite. Far too many of the 24 million people who will become uninsured are the sick, the poor, and seniors."
Dr. Joyce Adams, a retired Clinical Professor of Pediatrics in Sacramento, CA, penned a letter to the editor in the Sacramento Bee. It read, in part:
"Doctors are caring for millions of patients with chronic diseases who cannot afford to have their care disrupted. We want our patients and communities to be able to get the health care they need. Our children must have access to health care that is equitable, affordable and high quality. The House plan falls far short of this goal and puts the coverage of millions of patients at risk. I urge people to tell Congress to oppose this bill."
CA State Coordinator Jose Tapia and others met with the Republican members of the California congressional delegation to express concerns about how much money California would lose if the House bill passed. Most of the staff understood the concern.
Dr. Theresa Rohr-Kirchgraber’s letter to the editor was published in the Indy Star.
“We need to give Hoosier patients the care they deserve and this plan will threaten care women receive for preventive services and increase rates on seniors, allows insurance companies to charge people -- including people with pre-existing conditions -- 30 percent more if they have a gap in coverage. This breaks Trump's promise of healthcare for everybody.”
Dr. Jennifer Chuang, also a candidate for the NJ State Assembly, wrote an op-ed in the Courier Post titled, A doctor’s take on why GOP health plan is bad medicine.
“Medical societies are voicing concerns about this healthcare bill because to not do so would do harm to our patients. It is now time for physicians to take our advocacy for our patients out of the office and bring it to the public.”
Dr. Lisa Plymate held a meeting with a coalition in Seattle, WA where they discussed their plans for the upcoming March 26th Consult Day and efforts to fight ACA repeal. She also shares that a member of the coalition, Dr. Rupin Thakkar, had a LTE published in the Seattle Times.
Dr. Alice Chen emceed the finale of the Save My Care Bus Tour at a press conference featuring House Minority Leader Nancy Pelosi, Senate Minority Leader Chuck Schumer, New Hampshire Senator Maggie Hassan, Buddy Henlock (a songwriter from Tennessee whose ACA insurance helped him get treated for Hep C), Paula Cheveney (a woman with stage 4 breast cancer who is on an ACA plan), and Steve Gomez (the father of an 18-month old who had a heart transplant and will need a great deal of health care for life).
Dr. Sanjeev Sriram moderated a Facebook Live session with Steve, Buddy, and Paula. The bus traveled 15,000 miles to 50 cities in 22 states with Doctors for America members participating in multiple states to highlight what ACA repeal would mean in real places across the country.
Dr. Cindy Haq shares that she met with Senator Tammy Baldwin at a town hall meeting in Milwaukee, WI. And, that Sen. Baldwin remains a strong advocate for universal health care coverage. She has also been meeting convening a group called ‘Healthcare for All-Southeast Wisconsin’ and is outreaching to the media media. Read this mention on her in the Journal Sentinel.
Tell us about what you are up to! Email your updates and photos to DFAHQ@drsforamerica.org.
- Send a letter to the editor of your local paper today about the House Republican ACA repeal bill. Numerous members have already submitted LTEs to papers across the nation. We need everyone to make their voice heard in every state across the country, but it's even more important for those of us who have a Republican House member.
- Register for the 2017 National Leadership Conference for the opportunity to connect with and learn from fellow advocates across the nation who are organizing for quality, affordable healthcare.
|What has been eliminated in ACHA||New or changed by ACHA|
|Provision allowing children to stay on parents' insurance plans until 26||Variety of taxes included in the ACA, effective after December 31, 2017: medical device tax; branded prescription drug tax; health insurance tax; tanning tax; 0.9% surcharge tax for high-earners (above $250,000) and 3.8% tax on investments||As a substitute to the individual mandate, allows insurers to charge a one year 30% surcharge on premiums to consumers that do not maintain continuous coverage|
|Requirement that insurers accept everyone regardless of pre-existing conditions||Enforcement of individual mandate||Continuous coverage penalty kicks in if individual experiences 63 or more continuous days without coverage in a 12-month look back period|
|40% Cadillac tax on high value plans but implementation is delayed until 2025||Enforcement of employer mandate||Premium rating change for older enrollees - under the ACA, older enrollees could not be required to pay more than 3X the rate of younger enrollees; under ACHA, required to pay more than 5X rate of younger enrollees|
|Employer tax exclusion for health coverage||Medicaid funding for Planned Parenthood and other organizations that perform abortions||Expanded tax break for health insurers; plans can write off up to $1M of executives' performance-based pay from their tax bill (previously $500,000 write-off)|
|Prohibition on lifetime and annual dollar limits||Use of tax credits to purchase a health plan that covers abortions||Changes to HSAs and the maximum amount an individual can contribute to his or her HSA ($6,500 for an individual; $13,100 for a family) starting in 2018|
|Limit on out-of-pocket minimums||ACA-mandated Medicaid DSH cuts, slated to start in FY2018, for non-expansion states eliminated||Re-instates retiree drug deduction for employers recieving Medicare Part D prescription drug subsidy starting in 2018|
|Required coverage for routine costs of clinical trials||In expansion states, DSH cuts repealed starting in FY2020||Removes ACA prohibition on reimbursement for tax-free OTC drugs starting in 2018|
|Ban on recissions||Minimum essential benefits requirement in Medicaid expansion plans at the end of 2019||New "high-risk" pool safety net funding of $10 billion pool among non-expansion states from 2018 through 2022|
|Uniform coverage of emergency room services for in-network and out-of-network visits||ACA subsidy to reduce low-income enrollees' cost-sharing in private health plans, effective at the end of 2019||Gradual phase-out of Medicaid expansion starting in 2020; shifts Medicaid funding from current, open-ended federal matching payments to block grant model in FY2020 (per capita cap subject to income inflation)|
|Employer reporting regulations||Medicaid: ACA requirements that the benchmark benefit package for Medicaid expansion population be equivalent to the ACA essential health benefits eliminated as of December 31, 2019||Current enrollees can stay in current Medicaid structure until 2020 until they leave program|
|Requirement to cover 10 essential health benefits (EHBs) including maternity care and preventative services (individual and small group phased out in Medicaid expansion by 2020)||ACA income-based tax creditreplaced by age-based advanceable refundable tax credit program in 2020|
Prohibition on waiting periods in excess of 90 days
DOCTORS IN ACTION
Tell us about what you are up to! Email your updates and photos to DFAHQ@drsforamerica.org.
Dr. Nicholas Vasquez shares that a group of emergency room doctors when to Capitol Hill to meet with Arizona leaders about the importance of keeping Medicaid expansion. They made it clear that doctors in their state, which expanded Medicaid, are not supportive of block grants.
Dr. Jay W. Lee, Chief Medical Officer at the Venice Family Clinic, wrote an op-ed in Medium highlighting the moral reasons for not repealing the ACA.
“Did you know as many as 45,000 preventable deaths are linked to lack of health care coverage every year? Before Obamacare, I remember the heartache of caring for patients who didn’t have health insurance or who had inadequate health coverage. People died early due to lack of access to medications or lack of access to surgeries. When Obamacare finally passed, the chief comment I heard became: “I haven’t seen a doctor in 10 years. I’m so happy to be here today.”
First year medical student Jay Dumainian wrote a letter to the editor about cutting Public Health Funds which was published in the Chicago Tribune.
“U.S. House Speaker Paul Ryan and the Republican Party like to paint themselves as the party of fiscal responsibility. But the plan he unfurled on Monday cuts back some core health care initiatives that health care experts of all political walks agree are essential to keeping costs down and Americans healthy. In particular, the Affordable Care Act’s Prevention and Public Health Fund finds no quarter in the GOP plans, which trims the public health fund’s $1 billion budget to a big round number.”
Dr. Seanta Danica Clark joined the Save My Care Bus at stops in Charlotte and Greensboro, North Carolina where speakers discussed how the House Republican plan would mean fewer covered, weaker protections, higher costs and worse coverage.
Annie Liu shares that she and other medical students at the University of Pittsburgh are collecting signatures for a letter to PA lawmakers asking them to protect the ACA. They plan to deliver the letters, along with educational materials and patient stories, to city, state, and national lawmakers in Pittsburgh.
Jonathan Staloff, a rising third year medical student at Brown University and founder of Brown Medical Students for the ACA shares, that he recently spoke at a ACA rally organized by Rhode Island’s Congressional delegation. Other speakers at the event included Senator Whitehouse, Senator Reed, and Congressman Langevin. You can watch the video here.
Dr. Dipesh Navsaria penned an op-ed in the CAP Times about the Republican ACA repeal bill. Read more here.
“It changes Medicaid to a per capita block grant in 2020. This means a set amount of money is laid out per person to cover the cost of providing Medicaid. While this may not seem like a big problem, this is more or less what is already done in Puerto Rico. In many years, they ran out of money before the fiscal year ended. Then — Zika happened.”
The House Republicans released their bill to repeal and replace major provisions of the ACA on Monday night. We cannot let this bill become law.
Their bill would make it harder for millions of people to afford health coverage. Leaders in Congress want to rush through the process and make it law by the end of March without any public hearings or even waiting for a score on cost and impact from the nonpartisan Congressional Budget Office.
The public needs to know what's happening, and the people they trust far more than Congress are doctors and medical students.
|Send a letter to the editor of your local paper today.|
Health care is complicated, but what doctors and medical students want for our patients is very straightforward. We want our patients and communities to be able to get the health care they need. We want equitable, affordable, high-quality health care to be a basic right for everyone - no matter what your age, income, or health status.
Members of Congress and the Trump administration may claim to be working toward the same goals, but their policies would do the opposite. Here are some important changes the bill would make to the Affordable Care Act:
- Effectively ends Medicaid expansion by ending federal funding, starting in 2020; and caps Medicaid payments to states, virtually ensuring the patients that need it most would have reduced access to lifesaving coverage and benefits.
- Takes away insurance coverage from millions by cutting tax credits for lower- and moderate-income people - the people who need assistance the most. Instead of providing tax credits that scale up with financial need (as the ACA does), it would be based primarily on age, which means the lowest income people would see the greatest cuts in their tax credits.
- Increases health care costs for millions by allowing insurance companies to charge seniors five times as much as young people and allowing insurance companies to charge people - including people with pre-existing conditions - 30 percent more if they have any gap in coverage.
- Defunds Planned Parenthood by preventing any federal health care funds to go toward Planned Parenthood's essential services like Pap smears, mammograms, and contraception - even though they are the only provider of these services in many underserved communities.
- Provides tax breaks for the wealthiest by cutting the taxes on the wealthy and the pharmaceutical and insurance industries that have made it possible for lower income Americans to afford health care.
- Rolls back progress on preventing chronic disease by eliminating the Public Health and Prevention Fund, which funds a significant portion of the CDC's budget and important community prevention efforts that target tobacco cessation, improving nutrition, and other evidence-based programs.
- Breaks President Trump's promise of "insurance for everybody."
We cannot let Congress pass this bill. Write a quick letter to the editor of your local paper now. Members of Congress read their local papers, and it will make a difference.
Poll after poll shows that the American public trusts doctors far more than members of Congress when it comes to health policies, and for good reason. We joined this profession to help people in their times of need. This is one of those times. Send a letter, and let us know when it gets published!
Thank you for all you do,
R. Scott Poppen, MD MPA
This week saw the signing of the second version of the executive order banning nationals from Muslim-majority countries from traveling to the U.S. - this time permitting current visa holders and citizens of Iraq.
The initial travel ban signed on January 27th and its revision come at the same time as the new administration has cracked down on illegal immigration with new deportation policies and stricter border controls. In addition, this year has seen an uptick of acts of intimidation against minorities with acts of violence specifically against Indian Americans, including two engineers, occurring in recent weeks.
It's in this atmosphere that it is necessary to point out the valuable, arguably essential, part that foreign-educated graduates play in our medical system. Just as in other technology heavy fields, foreign graduates work at every level of health care system - in clinical medicine as nurses, pharmacists and physicians and as graduate students and researchers in academia and private industry working to further the basic science and clinical research that is at the heart of medical innovation.
A recent analysis done by Harvard Medical School faculty found foreign trained doctors make up 21% of those working in the U.S. - a total of over 164,000 physicians. Of this group, over 8,000 physicians are from the seven nations targeted in the first travel ban.
Immigrant doctors are especially essential to the rural healthcare system. Foreign nationals, seeking visa guarantees from employers, will often choose to work in rural areas that highly-trained U.S. citizens are leaving behind. The Immigrant Doctors Project, an analysis performed by MIT and Harvard graduate students, found that physicians from the banned nations are most heavily concentrated in the rust-belt states of Michigan and Ohio. At a time where there is a profound physician shortage in rural counties it makes no sense to restrict the entrance of professionals who are willing and able to work in these areas.
In addition to those directly targeted by the ban it appears recent events have the potential to produce a chilling effect on highly-skilled immigration from other nations as well. According to Science Magazine, engineering programs in the U.S. have seen a drop in the number of applications from international students. This is a trend that could foreshadow next year’s residency match in the US.
As the response to first iteration of the Trump travel ban showed, many Americans are not on board with the inward-looking and short-sighted policy positions of the current administration. As the social and legal response to the new ban begins we need to remember that protecting and improving U.S. healthcare remains another important reason to oppose these orders.
Osmaan A. Minhas, DO
2nd Year Family Medicine Resident
Orange Regional Medicine Center, Middletown NY
Trump’s New Travel Ban Could Affect Doctors, Especially In The Rust Belt And Appalachia. https://fivethirtyeight.com/features/trumps-new-travel-ban-could-affect-doctors-especially-in-the-rust-belt-and-appalachia/#fn-2 Published March 6, 2017.
The Immigrant Doctors Project. https://immigrantdoctors.org/ Published January 2017.
Drop in foreign applicants worries U.S. engineering schools. http://www.sciencemag.org/news/2017/02/drop-foreign-applicants-worries-us-engineering-schools Published Feburary 14, 2010.
The Immigration Ban And The Physician Workforce. http://healthaffairs.org/blog/2017/03/06/the-immigration-ban-and-the-physician-workforce/ Published March 6, 2017.
Denying Visas to Doctors in the United States. N Engl J Med. 2017; DOI: 10.1056/NEJMc1616421
Doctors for America is circulating a news round-up to help keep our membership updated on the latest in health reform and ACA repeal activities. Every action that we take is making a difference in shaping the conversation in communities and in Congress, so please keep it up! Millions of people are depending on what happens in Congress in the coming weeks.
ACA Round Up - March 3, 2017
Republicans in Congress are keeping details of their health law replacement plan secret, allowing only Republican members and staffers to view the bill. Spread the word via social media that this process should be open and transparent to allow for input, hearings, and a CBO score before the first vote is cast on a bill that will affect the lives and wallets of millions of Americans.
Members of Doctors for America have talked to the offices of members of Congress across the country in the past couple of days. If you have not yet called, even on the weekend, the voice messages you leave will show Congress that we are serious about standing up for our patients.
For additional information on how to take action, please visit the DFA ACA resource page.
Following the leak of a formal draft of the House Republican plan to replace the Affordable Care Act last Friday, President Donald Trump made health reform a central part of his address to a joint session of Congressthis past week, touting many of the same proposals that have been previously socialized among political leadership—allowing insurers to sell plans across state lines, expanding health savings accounts and increasing competition to decrease costs. Still, some conservatives are opposed to the leaked plan, which aligns with much of House Speaker Paul Ryan’s ‘A Better Way’ plan. Trump has also endorsed tax creditsamong other reforms, deviating from the traditional conservative approach to replacement. Leaders of the conservative Republican Study Committee and House Freedom Caucus stated early in the week that they would oppose a draft of a plan that included tax credits, referring to them as a new entitlement program.
On Thursday, House Republican leadership released their formal repeal and replace bill. Unfortunately, efforts to see this bill were thwarted by top-level security measures that restricted viewing access to members of the House Energy and Commerce Committee. Based on the leaked draft from last week, it is anticipated that the bill includes significant cuts to Medicaid, especially for those states that have expanded Medicaid under the ACA.
The bill, which is scheduled to be reviewed in committee next Wednesday, has not yet been reviewed by the Congressional Budget Office (CBO), which will provide a “score” on the cost as well as an estimate on how many people will receive insurance under the plan. It is unlikely that the CBO will be able to provide that score before committee discussions and votes.
Several meetings were held this past week between the administration and lawmakers to forge a path forward for replacement, including a meeting with Republican governors, some from states that had accepted Medicaid expansion and others from states that had not, with each group wanting to ensure that any new legislation would be fair. Some governors have also drafted their own proposals to repeal and replace the Affordable Care Act, aiming to preserve more of the law than congressional Republicans currently envisioned.
Trump also met with health insurance CEOs to discuss short-term marketplace stability and “long-term improvement” for the industry. Amidst all these meetings, plan specifics are still shrouded in secrecy as the fundamental forces reinforcing divisive opinions amongst political leadership continue to make a palatable replacement plan elusive. For some providers, delay in a concrete replacement are favored, as the timeline shifts further out for any changes to government healthcare payments.
Meanwhile, Obamacare proponents across the country attended more than 100 rallies last week, demonstrating public support for the health law. This public support is one of the reasons discussions in Congress have been so contentious to date.
The Senate Finance Committee has also voted to advance Seema Vermaas the next Centers for Medicare and Medicaid administrator. Certain members of the committee had opposed her nomination based on concerns regarding her Medicare experience, as well as statements regarding optional maternity coverage and other health policies.
And in his first address to Congress, Trump also reiterated his call to tackle high prescription drug prices. Senator Bernie Sanders (I-VT) and other Democratic lawmakers introduced a bill that would allow the importation of drugs from Canadian pharmacies, granted that certain safety standards were met. The bill is likely to face opposition from the Pharmaceutical Researchers and Manufacturers of America and other organizations.
It is evident that those fundamental forces which have made coalescence around a single plan difficult thus far are still at play, and cast uncertainty for industry stakeholders and the health system at large while we await details of the House repeal and replace bill.
MEMBERS IN ACTION
Tell us about what you are up to! Email your updates and photos to DFAHQ@drsforamerica.org.
DC Doctor Speaks Up for Medicaid
Dr. Sanjeev Sriram has been speaking out against efforts by Congressional Republicans to block grant Medicaid, effectively ending Medicaid as we know it. Check out what he has been up to:
Dr. America podcast: Dr America's Valentines for Medicaid
Save My Care Bus in Florida
The Save My Care Bus rolled into Florida this week. DFA Chair Dr. Mona Mangat spoke at the Tampa stop, and Florida State Director Dr. Anna Lizama spoke in Orlando about the devastating consequences of repealing health care for millions of Americans.
Illinois Round Table Discussion
Dr. Ram Krishnamoorthi shares that he met with Congressman Raja Krishnamoorthi who convened a round table discussion of policy experts, health professionals, and community stakeholders to discuss the consequences of repealing the ACA.
Louisiana Med Students Voice Concerns with Sen. Cassidy
Keanan McGonigle shares that a group of Tulane medical students have been actively engaging with Senator Cassidy’s office, given he is one of the cosponsors of a Republican ACA “replacement” bill. Earlier this month, AMSA hosted two activism trainings with medical students and community members. The students put their newly-acquired skills to use the following week at a town hall with Senator Cassidy, where they spoke about his plan for the ACA. About 200 people were allowed into the town hall – approximately 700 people were waiting outside. In addition to attending the town hall, students also visited Senator Cassidy's office in Metairie, LA and met with his regional director. They expressed their concerns that cutting federal funding for coverage and services in a poorer state like Louisiana would make it difficult to attract highly-qualified medical professionals to care for residents. There they presented a letter signed by around 120 medical student and community members about not cutting access to or coverage for services. A summary of this outreach is available here. And, you can find student quotes in the New Orleans Advocate and WDSU.
DFA-NY Holds Happy Hour Meeting
DFA-NY/Mount Sinai held a February Happy Hour meeting where they developed actions and ideas to help #protectourpatients.
Ohio Town Hall With Rep. Marcia Fudge
Dr. Arthur Lavin shares that Congresswoman Marcia Fudge (D-OH) held a Town Hall meeting on February 25th. It was a crowd bursting at the seams, and the Ohio chapter of the DFA was there. The tone of the Town Hall was one of profound apprehension. The packed hall was attentive, and participatory. Most of the time was spent on questions and answers. Questioners rapidly created a long line, and every question was asked. One of the first questioners was a doctor, and the Congresswoman asked all the doctors at the Town Hall to stand up. Out of the hundreds present, several dozen doctors and nurses stood up, the crowd roared. Many of the questions were directed at protecting the ACA, several were patients who would be dead without it or with repeal. Hope was in the air, but with profound apprehension.
DFA Holds Town Hall in Ohio
Dr. Donald Nguyen shares that Doctors for America held a town hall event in Centerville, OH, on February 25th in partnership with Organizing for Action and other local organizations to discuss the current health care system, specifically the ACA. more than 400 people attended and many shared stories about how the ACA has impacted their lives. They discussed the possible replacement options that Republicans in Congress are proposing. While invited, Senator Rob Portman did not attend. Check out all of the amazing coverage in the Dayton Daily News, WHIO, Fox 45, ABC 22. A recording of the event is available here and a powerful video of a 13 yr old cancer survivor who spoke is here.
Utah Doctor Pens Op-Ed
Dr. Julie Day penned an op-ed for the Salt Lake Tribune where she discusses how repeal of the ACA could be a bitter pill for the GOP. Read the full piece here.
“As citizens with a lot at stake, we will have to insist on rigorous analysis of the various options that are being proposed. We will have to take the CBO seriously. We will have to insist that our economy, our health, and our futures not be destabilized to satisfy a stale, bitter, political promise to repeal Obamacare.”
Kaiser Health Tracking Poll: Future Directions for the ACA and Medicaid
KFF: How Affordable Care Act Repeal and Replace Plans Might Shift Health Insurance Tax Credits
New York Times: Trump Idea to Expand Health Care Competition Faces Hurdles
Modern Healthcare: Employers gear up for next fight after Cadillac tax
Health Affairs: States be Warned: High-Risk Pools Offer Little Help at a High Cost
Commonwealth Fund: The Financial Consequences of Terminating the ACA's Cost Sharing Reduction Payments
Doctors for America is circulating a news round-up to help keep our membership updated on the latest in health reform and ACA repeal activities in the United States. For additional information on how to take action, please visit the DFA ACA resource page.
ACA Round Up - February 24, 2017
Join health professionals' rallies this Saturday, February 25 to echo the "don't take away our patients' care" message in front of local Congressional and governor offices. Stories, signs and masses in front of these offices will demonstrate how important care and coverage are in sickness & wellness, and life & death for the patients we treat.
Save the date! Please join us for the 2017 Doctors for America National Leadership Conference to be held in Tampa, Florida on May 6th and 7th. A leadership training will be offered on Friday, May 5th. Limited spaces will be available for the training. Mark your calendars. Registration will be opening soon.
This week marks the first extended Congressional recess of President Donald Trump's tenure. The Trump administration has indicated that they may be taking a more hands-off approach to drafting health legislation, and that health law repair is still a viable consideration in this ongoing debate. The administration continues to take action on the ACA, by extending exchange filing deadlines, postponing action on their lawsuit against Obamacare exchange subsidies and issuing a one year extension for individual and small-group health plans that do not comply with ACA coverage rules.
In a shift from previous strategy, Department of Health and Human Services Secretary Tom Price told House Republicans that the administration would not be sending them a replacement plan. Instead, the White House plans to "cooperate and provide input" into the GOP plan. President Trump had previously stated that his administration would release a plan shortly after the HHS Secretary confirmation. On Wednesday, Trump indicated that a healthcare plan would be coming in "mid to early March."
Last week Paul Ryan had indicated that the Republicans would be ready to submit a bill after recess; however, events this week have shown that there is still no consensus on many specifics. Senator Lisa Murkowski (R-Alaska) indicated that she would not vote to repeal Medicaid expansion or support legislation to pull federal funding for Planned Parenthood. Other Republicans have expressed support for maternity coverage, an issue that the Centers for Medicare & Medicaid director nominee Seema Verma had indicated might be on the table, during her hearing last week. Conservative House members are pushing for a fast repeal of Obamacare with only a bare-bones replacement to follow. Other political leaders are interested in taking more time to come up with a replacement plan. And former House Speaker John Boehner predicted on Thursday that a full repeal and replace of Obamacare is “not what’s going to happen” and that Republicans will instead make fixes to the law. His statements were countered quickly by Senator Ted Cruz (R-Texas) at a Conservative Political Action Committee meeting, dismissing constituent concerns at recess week townhalls. At this same meeting Senator Cruz predicted that there would be another Supreme Court vacancy this summer.
Concurrently, groups took the opportunity to express their point of view. On Wednesday, One Nation, an advocacy group linked to Senate Majority Leader Mitch McConnell, launched an ad campaign in nine states urging repeal and replace. This sent a message to the Freedom Caucus and other conservative groups that their repeal-first demands are out of step with public opinion. Alongside this, more than 130 mayors signed a bipartisan letter to congressional leaders in support of several ACA provisions. Marilyn Tavenner, president and CEO of America's Health Insurance Plans, and Rick Pollack, American Hospital Association's president and CEO, have also urged Congress to focus on stabilizing the individual health insurance exchange for 2018 before attempting to tackle Medicaid reform. The two groups have been largely silent up to this point and so such comments represent a significant voice in dialogue around health reform. The National Governors Association meeting kicks off today, with health care as a major focus of discussion. And lastly, spirited town hall meetings have continued to play a role in shaping political discourse. Meetings between members of Congress and health care professionals, patients, caregivers and hospital managers continue to take place.
MEMBERS IN ACTION
Have you hosted a house meeting or meet with your member of Congress? If so, send an update and photo to DFAHQ@drsforamerica.org. If not, there is still time! Learn more at the DFA House Meeting (Get Together) Host Guide.
Connecticut Students Hold Vigil
Kristen Zozulin shares that, as part of the #ProtectOurPatients Day of Action, medical students with the DFA chapter at Frank H. Netter MD School of Medicine at Quinnipiac University hosted a "Vigil for the Victims of Healthcare Inequity," where they discussed inequity and bias in the U.S. healthcare system as well as medical school. They also talked about ways to get students and faculty more involved in discussions and events promoting diversity and justice in healthcare.
Kentucky Panel Discussion
Mallika Sabharwal, a second year student at the University of Louisville School of Medicine (ULSOM) shares that ULSOM Students for a National Health Program, Student National Medical Association, and Advocates for Healthcare Information held a health care panel discussion with Representative John Yarmuth, Dr. Susan Buchino, and Dr. Barbara Casper to focus on the impact of the ACA in Kentucky. Panelists discussed the financial and social benefits of ACA implementation in the state and the likely outcomes of ACA repeal. Medicare-for-all was also discussed as the best alternative to/ improvement upon the ACA (to applause from the audience). Over 100 people attended, which included many faculty and students.
Ohio Recess Activity
Gloria Tavera shares that a team of advocates stood outside Sen. Rob Portmans' office in downtown Cleveland. They urged no repeal without a replacement that covers more people, not less, and provides healthcare that is at least as good as what Rob Portman currently enjoys as a US Senator. Students at CWRU also demonstrated outside of the office of Senator Portman. They delivered a letter sharing a patient story to his office and emphasized that his constituents are disappointed in the lack of public town halls this week. Read more about their recess activity in the Cleveland Plain Dealer.
Washington House Meeting
Dr. Lisa Plymate held a meeting at Charles Mayer's house in Seattle with a coalition of doctors, all intent on saving the ACA, Medicaid and Medicare. They had a great group of 20 people in attendance. The next in-person meeting will be 3/12 at yet another home - they’re rotating for fun.
Tell us about what you are up to! Email your updates and photos to DFAHQ@drsforamerica.org.
Modern Healthcare: Filing extensions may not be enough to keep insurers in individual market
Center on Budget and Public Priorities: Report on House Republican proposals to radically overhaul Medicaid would shift costs, risks to states
The Hill: Boehner: Obamacare repeal and replace 'not going to happen'
Kaiser Family Foundation Health Tracking Poll: The Public's Views on the ACA
CNN Money: Republicans postpone settling Obamacare subsidies lawsuit
Bloomberg: Allergan CEO pushes Trump to lead drug price discussions
Modern Healthcare: Anthem hopes to close Cigna deal under Trump Justice Department
- Host a house meeting during the Congressional recess week. Host a meeting to make a plan to ensure sure your members of Congress are hearing from doctors, medical students, and community members about the real impact of the ACA. In these challenging times, the power we build locally is more important than ever before. Meeting resources below:
- Nancy Pelosi and House Democrats are hosting nationwide rallies in defense of the Affordable Care Act, Medicaid and Medicare, during the recess period. Contact your Representative to find out if there is an event in your area. Then join a rally in your white coats and send photos and a brief description to DFAHQ@drsforamerica.org.
- Please join us for the 2017 Doctors for America National Leadership Conference to be held in Tampa, Florida on May 6-7th. A leadership training will be offered for a limited number of members on Friday, May 5th. Mark your calendars. Registration will be opening soon.
Yesterday, House Republican leaders held a meeting to enumerate their plans to repeal-and-replace the Affordable Care Act. This meeting came as leaders attempt to unite sharply divided GOP members around a single replacement plan, and quell rising public fears around repeal without a viable alternative. The newly released plan incorporates tax credits, an expansion of health savings accounts, funding for high risk pools and a reduction in Medicaid funding to pre-expansion levels. The plan largely reflects the 'Better Way' proposal that Speaker Paul Ryan released last summer; but, does not include changes to Medicare, which President Donald Trump has stated he will not support converting into a voucher program. This plan follows another House Freedom Caucus proposal, introduced on Wednesday by Senator Rand Paul (R-KY) and Representative Mark Meadows (R-NC), reinforcing GOP discordance on key issues. House Freedom Caucus leaders also demanded that congressional Republicans re-pass the 2015 budget reconciliation bill to vote to repeal most of the Affordable Care Act. The bill was previously passed and vetoed by former President Barack Obama.
Concurrently, there are efforts to continue moving forward with current ACA challenges. Following Trump's executive order on health care, the IRS has planned to ease enforcement of the individual mandate, an Obamacare provision which requires people to have insurance coverage or risk fines. This change is accompanied by new reforms proposed by the Centers for Medicare & Medicaid Services to stabilize the individual and group health insurance markets for 2018. Constricting the annual enrollment period, adjusting minimum coverage standards and deferring review of provider network adequacy to the states are among several policy and operational changes detailed in the proposed regulations. The rule has drawn mixed reviews from industry groups and experts.
Despite actions intended to stabilize the markets, health insurance players are still hesitant to fully participate in the Obamacare exchanges. Humana has also announced that it will withdraw from the federal marketplaces in 2018. This will affect approximately 150,000 consumers in 11 states where Humana is currently selling Obamacare plans. Aetna made a similar decision in early February, indicating that insurers need more clarity on the road ahead.
And just as the Centers for Medicare & Medicaid Services proposed these reforms, Seema Verma faced ethical questions regarding conflicts of interest during her Senate Finance Committee hearing to oversee the agency. It is expected that Verma will be confirmed on a party line vote, much like other Trump administration nominees. Deviating from other contentious nominations though, David Shulkin was swiftly and unanimously confirmed as Veterans' Affairs Secretary. He has vowed to increase accountability, dramatically improve access and expand care options, and assuaged fears that the VA system would be privatized, stating in his testimony: "The Department of Veterans Affairs will not be privatized under my watch." Meanwhile, Democratic leadership has called for nationwide rallies against Obamacare repeal, on February 25th. Senate Minority Leader Chuck Schumer (D-NY) and Senator Bernie Sanders (I-VT) issued a letter encouraging Democratic senators to lead rallies in their states at the end of the February congressional recess week.
Lastly, the biopharmaceutical industry is pushing back on a Trump proposal to deregulate the Food & Drug Administration. The industry is already under fire for high prices, including Marathon Pharmaceuticals LLC which recently 'paused' the launch of its $89,000-a-year musculary dystrophy drug. Moreover, pharmaceutical and biotechnology firms cite that a loose approval process limits industry ability to prove the value of more expensive medicines, especially as payers are increasingly seeking evidence of value and improved outcomes.
MEMBERS IN ACTION
Justin Lowenthal MD/PhD student shares that DFA MD and Hopkins University held a chapter meeting to discuss recent developments around the ACA.
The Hopkins Chapter of Doctors for America also put on an interprofessional phone banking event with medical, nursing, public health students, and residents. The students called senators urging them to protect the ACA. The event was jointly organized by DFA and #ProtectOurPatients.
North Carolina March
Dr. Seanta Clark attended the HKonJ march in Raleigh, NC. Approximately 100,000 people came together for the march which theme was "Forward Together, Not One Step Back."
Dr. Howard Eisenson also stood alongside a “white coat brigade” of professionals from across for the march on Raleigh. The event drew over 100 white coats including many medical students.
Ohio #ProtectOurPatients Forum
Gloria Tavera, an MD/PhD student from CWRU, participated in a #ProtectOurPatients health justice community forum where a team of 60 people formed to take on health care justice in Northeast Ohio. More photos from the event are available here.
Pennsylvania House Meeting
Five Pittsburgh-area physicians Drs. Sharon Altman, Jessica Gannon, Sarah Larkin, Jason Rosenstock and Holly Stewart met February 11th for a health care advocacy and strategy session, inspired by Doctors for America. The team provide mutual support and developed ways to move forward with action, such as writing letters to the editor, talking to our patients about the current situation, donating to key causes/organizations, and contacting our elected representatives. They plan to involve colleagues and track progress over time, staying in touch as we move forward.
Texas Physician Meeting
Dr. Laeeq Khan hosted a meeting with five Houston area physicians and medical students on Sunday Feb 12 to discuss efforts to repeal the health law.
Dr. Lisa Plymate joined with doctors and medical students for a meeting of about 20 people, including University of Washington medical students, in Seattle.
Kaiser Family Foundation: Tool to compare proposals to replace the Affordable Care Act
Modern Healthcare: Why high-risk pools won't crack the pre-existing condition dilemma
NPR Health News: Republican health care proposal would cover fewer low-income families
Vox: Congress is repealing a rule that makes it harder for people with mental illness to buy a gun
New York Times: Angry Town Hall Meetings on Health Care Law, and few Answers
CALL-IN DAY: While many calls are being driven into offices, sustained outreach to Congress is a very important component of keeping up the pressure to keep people covered especially as we head toward in-district actions during the February recess. To that end, SEIU is having another national call-in day on Tuesday, Feb. 14 and they are having activists take an additional step by posting on their social media platforms a personalized video, photo and/or written message about how they, their loved ones or patients would be affected if affordable healthcare, including Medicaid, is taken away. They are using the hashtag #WhatsYourPlan and asking folks to tag their members of Congress to get a greater reach.Please join SEIU by sharing the call-in numbers: 866-426-2631 (
English) and 877-736-7831 (Spanish). There is also a Facebook event invite that would be helpful to promote.DONATE: Tom Price was confirmed today as Secretary of Health and Human Services. Sec. Price takes over a time when the future of the Affordable Care Act, Medicaid and even Medicare are in jeopardy. Millions of patients are relying on the voices of doctors and medical students to protect their care. Please take a moment to give what you can to help ensure we have the funds necessary in the year ahead. Give today.
The confirmation today of Tom Price as Secretary of Health and Human Services is seen as a necessary step forward in the Republican effort to repeal and replace the Affordable Care Act (ACA). Already, the administration has started to pull Obamacare mentions from the White House website, which demonstrates their zealous intent to initiate rapid repeal of the health law. Other terminology being floated for the scale-back process is 'Reconciliation Plus' or 'repeal and repair'. All of this still reflects the reality that there is still no consensus on a final strategy or replacement plan for the ACA. President Trump has said that his administration would release their own plan soon after Tom Price's confirmation. The House Freedom Caucus has stated that they will also introduce their bill next week, one that is said to be similar to Senator Rand Paul's (R-KY) proposal.
On Sunday, President Trump stated that a replacement for the ACA could stretch into 2018, a much longer time frame than he previously indicated. Paul Ryan has restated that a March to April timeframe is still the goal. Likewise there was some confusion this week about President Trump's position on Medicare drug price negotiation. Biopharma stock prices fell once again when White House Press Secretary Sean Spicer indicated that President Trump supported these negotiations. Spicer’s comments took investors by surprise after Trump appeared to have backed away from the idea last week after a meeting with top pharmaceutical CEOs.
On Wednesday, House Democrats gathered in Baltimore for their annual three-day retreat to strategize for the upcoming session of Congress. The theme for the retreat was “Fighting for All Americans,” and included a report on the 2016 election. Democrats are currently in resistance mode in regard to Trump's nominees and policies; but, some are questioning whether this is the right strategy to adopt. A new poll from Morning Consult and Politico suggests that while 56% of Democratic voters want their party to pursue obstruction, the majority of most other major demographics want Democrats to cooperate with the new president and Republican-controlled Congress. This insight could potentially guide congressional approaches to health reform and other health policy legislation moving forward.
This week Republicans also faced increased public backlash in town hall meetings. ACA supporters flooded town hall events this week in California, Florida and Utah, where Republican lawmakers faced jeering crowds and tough questions about repealing the ACA without an alternative in place. In tandem, polls are suggesting that Americans still don't understand that Obamacare and the Affordable Care Act are one in the same.
Advocacy and industry groups are also positioning themselves for a battle on various fronts. AARP is considering filing a lawsuit against the Trump administration over a potential age rating band change that was disclosed in a leaked HHS draft rule last week. And increasingly, states are taking action to shore up their health insurance market. Minnesota, for example, passed a one-time bailout for consumers in the individual insurance market facing high premiums, rejected an attempt to let insurers' offer bare bones coverage and laid the groundwork for public option for the individual market. Lastly, the 9th Circuit upheld the stay on Trump's immigration orderyesterday evening, signaling relief for many in the healthcare workforce serving patients in rural areas who depend on foreign-born physicians and healthcare professionals. We can expect there to be an appeal from the administration in the coming weeks, alongside continued reconciliation hearings and executive action from HHS Secretary Tom Price.
Doctors for America statement on confirmation of Tom Price as HHS Secretary:
"Doctors across the country are caring for patients who rely on Medicare, Medicaid, and their new insurance and protections gained through the Affordable Care Act. We disagree with Secretary Price's previous policy positions that we believe would weaken these programs for patients. We therefore call upon him as a fellow physician to examine the evidence and work with us to increase access to healthcare for everyone, especially those who need it the most." Read more here.