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ACA Round Up - 3/17

By Shalini Pammal
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 TAKE ACTION

  • 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.

 WEEK-AT-A-GLANCE

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 AssociationAmerican Hospital AssociationAARP 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."

California

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.


Indiana

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.”

New Jersey


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.”


Washington

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.

Washington, DC

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.

Wisconsin

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.

KEY ARTICLES

Kaiser Family Foundation: Restructuring Medicaid in the American Health Care Act: Five Key Considerations

Kaiser Family Foundation: Obamacare Pushed Nonprofits to Do Good Beyond Their Walls. Now What?

Vox: Trump's budget on health: 3 losers, 2 winners

Washington Examiner: Conservatives prep amendment to GOP's Obamacare repeal bill

Morning Consult: Wyden Introduces Bill to Increase Transparency of PBMs


 


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