Fight not over to preserve ideal patient care, says ACP

The American Health Care Act may have been shelved by Republicans, but its threat to patient care still looms.

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That’s according to representatives of the American College of Physicians, who have voiced their opposition to the legislation geared at repealing several provisions of the Affordable Care Act. The bill was scheduled for a vote by the U.S. House of Representatives on March 24, but was withdrawn by House leadership at the last minute.

Robert Doherty

“This was undoubtedly good news [for patients],” said ACP President Nitin Damle, MD, MACP, at the organization’s annual conference in San Diego. “The ACA is still at risk in the regulatory and legislative arena,” he added.

The College, who worked with several other physician organizations to voice their opposition to the bill, has heard that Republicans are working to revive the bill. House leadership is working with the House Freedom Caucus, the main voting bloc that would have doomed the bill had it come to a vote.

In addition, even though Obamacare is still the law of the land, it does not mean that the White House needs to support it.

Damle said the Trump Administration needs to decide if it wants to work with Democrats to improve the law or simply “sabotage” it.

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This could take many forms noted Robert Doherty, senior vice president of governmental affairs for the ACP, from not enforcing the law’s individual mandate to not encouraging enrollment in the exchanges for 2018. Following his inauguration, President Trump signed an executive order instructing federal agencies to take actions “within the law” to minimize any unwarranted economic and regulatory burdens of Obamacare.

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“Will they encourage sign up or simply sit on their hands?” asked Doherty. “…We know that when it comes to the individual insurance mandate, Republicans hate it. If they don’t enforce it, the young will opt out [of coverage] until they are sick.  This will create a death cycle for insurance.”

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Furthermore, with major healthcare insurers like Aetna and UnitedHealthcare already indicating their intent to withdraw from the healthcare insurance exchanges, Doherty said that the Trump Administration can work with Democrats to provide some help to insurers or simply let everything “explode” as the president has often said regarding the fate of Obamacare. “We are worried, by neglect or intent, that they will make things worse,” Doherty said.

Doherty also noted that in addition to Trump’s executive order regarding ACA burdens, the College is closely following the president’s pair of executive orders on immigration, both under a court injunction from taking full effect.

The latest order still restricts entry into the U.S. for many physicians and medical students, said Doherty. The ACP remains concerned the order is discriminatory and will restrict free travel by physicians and make it more difficult for physicians to gain visas. Doherty noted that 38% of internal medicine physicians are trained outside the U.S. and provide a disproportionate share of care in underserved communities nationwide.

Doherty said the travel ban would have a “devastating impact” on medical residents and remains under careful review by the ACP.