GOP Obamacare replacement bill puts physicians, patients in charge

On January 3, Republicans in the U.S. House of Representatives fired the first shot in the battle to replace the Affordable Care Act, in the form of their own legislation. The bill, known as the American Health Reform Act of 2017 would, among other provisions:

·      allow healthcare insurance to be sold across state lines,

·      increase the number of services which patients could pay for using health savings accounts (HSAs),

·      make it more difficult to sue physicians for malpractice, and

·      make federal money available to states to develop high-risk insurance pools for people with pre-existing conditions

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The bill was introduced by Representative Philip Roe, a former physician who represents Tennessee’s First Congressional District. Roe, who co-chairs the GOP Doctors Caucus in the House of Representatives, introduced similar legislation in the last two sessions of Congress. Roe spoke with Medical Economics about the bill’s purpose, and why repealing the ACA is such a high priority for Republicans in Congress:

Medical Economics:How does this version of the bill differ from previous ones, if at all?

Roe:  It does a little. We removed the 21^st Century Cures part of the bill, because we’d already covered that by the law [of the same name] that was passed late last year. But otherwise it’s the same, and what we wanted to do was get this bill introduced to show people that we did have ideas and a bill out there ready to go.

Now, I certainly understand this bill won’t be the final version of what’s passed. I had lunch with the Speaker (Paul Ryan, Speaker of the House of Representatives) [on January 5], and basically we don’t know exactly what we can put in reconciliation yet. So whatever can go into reconciliation can come out of that bill. For instance, if you can put expansion of HSAs in there, there’s no need to have them in that bill.

Number two, once the new secretary of the U.S. Department Health and Human Services is approved by the Senate, then there are things he can do just by the stroke of the pen.

The idea was to put those principles out, and I will tell you that 80% of the bill-selling insurance across state lines, malpractice reform, transparency, I think docs will really appreciate.

I’ve said from the very beginning, the bill is amendable. I’m more than happy to listen to Democrat ideas. Because I think one of the problems with the first bill (the ACA) is that Republicans were closed out of it.

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I think the real difference will be, do we add refundable tax credits in lieu of subsidies so that people can go out and purchase their health insurance on the open market, which has been essentially decimated by the ACA?

I wrote to governors asking them, if we had (healthcare) reform, how much of it would they like to do on the state level? The governor’s concern in Tennessee was pretty much the same concern we’ve heard about the (individual) mandate: the essential health benefits package is too restrictive.

ME:I’m sure you’re aware of the argument that the individual mandate is needed to get young, healthy people into the insurance pool so as to spread the risk around?

Roe: That was the theory. But look, there were 10.4 million people in the exchanges last year, and many of those didn’t get a subsidy. Almost as many people paid the penalty last year-eight million-as got a subsidy. So it isn’t working very well.

Next: What happens with the bill now?

I think a lot of people are saying at $1,500 a month (for premiums), if I’ve got to pay that, I’ll just pay the penalty. 

I’ll give you an example from my own experience. I had major back surgery three months ago. After paying the deductible, the hospital, the anesthesiologist and the neurosurgeon, the insurance company still made $5,000 on me. That’s how high the premiums are. I’d have been better off with just a catastrophic policy and paid for it myself. I add up all the bills and I add up what the premiums were for the year, and I thought, ‘Hey, I would have been $5,000 better off if I’d just paid cash and not had health insurance.’

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I have stacks of emails from small businesses paying $500 a month in premiums three years ago and now they’re paying $1,500 a month. And they’re having to decide, do I drop this and just take my chances? I’ve had them almost in tears coming to my office.

There isn’t any question about having to do healthcare reform, because this is doing exactly what Tenncare (Tennessee’s Medicaid program) did. The difference is, the federal government doesn’t have a balanced budget amendment in the Constitution, and we do in the state of Tennessee. So we didn’t have any choice when (Medicaid) blew the top off the market. We were trying to expand coverage to everyone, but costs tripled over the time we were trying, and it nearly bankrupted our state.

ME:Did you have any input from Democrats in writing this legislation?

Roe: No, this was a Republican Study Committee bill. My marching orders when I wrote this two Congresses ago, then revised it last Congress, was to basically allow doctors and their patients to be in charge of healthcare decisions, and to make it portable. To let the free market systems work better than they are now, because we’ve destroyed the free market in healthcare.

In Tennessee about 70 of our 95 counties have one choice (in healthcare insurance providers). And Blue Cross pulled out of ACA exchange-type plans in Memphis, Nashville and Chattanooga.

It (the healthcare insurance market) is already going away. It’s up to both Republicans and Democrats to step up and allow people a way to get away from this and get back to something they can afford, and I think we can do it. It’s not going to be easy, and I’ll admit there are people out there who’ve been helped by the ACA. You can’t spend a trillion dollars and not help somebody.

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ME:Are you hearing from any of those people? Are constituents saying, ‘Slow down, there are aspects of the ACA we like’?

Roe: I’ve had people that didn’t have health insurance before, but I’ve had as many or more who’ve said they’ve lost their health insurance because they can no longer afford it. So where we live it’s certainly a wash.

ME: What happens with the bill now?

Roe: We (Republicans in Congress) have a retreat in two weeks. The president and the vice president will be there. Healthcare reform will be number one on the agenda, and again, a lot of what we can do going forward depends on what the Senate parliamentarian allows us to put in the bill in a reconciliation package that we just need 51 votes for.

ME:Doesn’t it have to get past the House first?

Roe: Yeah, but we’ll pass it. But the Senate rules are very arcane, you have to have certain things in the bill. But the speaker did say yesterday and this morning at our conference meeting we’re going to do that this year.

There’s a great song by the Eagles, ‘The Heat is On.” And that’s what I’m trying to do: keep the heat on.