House Obamacare bill won’t fix healthcare system, doctors say

Physician groups are sharply criticizing Thursday’s vote in the U.S. House of Representatives to pass the American Health Care Act (AHCA), saying the bill would reduce or eliminate healthcare coverage for millions of Americans.

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The bill, which House leadership sees as fulfilling its pledge to repeal and replace Obamacare, was approved by a vote of 217 to 213. No Democrats voted in favor of the legislation. It now goes to the U.S. Senate, where most policy analysts believe it will be substantially revised.

The House bill would make sweeping changes to the healthcare marketplace created by Obamacare. Among these are:

· Allowing states to opt out of the Obamacare requirement that insurers cover “essential health benefits” such as hospitalization, pregnancy and maternity care and prescription drugs.

· Allowing states to opt out of Obamacare’s community rating requirement that insurers charge the same rates to all individuals in a given region, regardless of their health status. In states choosing to do this, insurers could charge a person more if he or she had gone more than two consecutive months without healthcare insurance.

· Ending the financial penalty for individuals who choose to go without health insurance

· Ending the expansion of Medicaid benefits included in Obamacare. States allowing the expansion received federal money to cover more of their residents. The AHCA would freeze enrollments under the new rules as of Jan. 1, 2020.

· Using age, rather than income, to determine the amount of tax credits provided to people buying healthcare insurance on the state or federal exchanges

In addition, the bill would repeal two tax hikes imposed on upper-income individuals and families under Obamacare and used to help pay for some of the legislation’s benefits-one on investment income, and one on Medicare taxes. It would also allocate $123 billion for states to use in establishing high-risk pools to cover people with pre-existing conditions.

Next: Medical associations sound off

Physicians’ organizations were quick to make known their disappointment with the House vote.

“The bill passed by the House today will result in millions of Americans losing access to quality, affordable health insurance and those with pre-existing health conditions face the possibility of going back to the time when insurers could charge them premiums that made access to coverage out of the question,” American Medical Association President Andrew Gurman, MD, said in a prepared statement.

In a statement from American College of Physicians (ACP) President Jack Ende, MD, MACP, the ACP said it’s “extremely disappointed” by the vote. “As a result, an estimated 24 million Americans will lose their coverage, and many more will be at risk of paying higher premiums and deductibles,” the college said.

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John Meigs Jr., MD, president of the American Academy of Family Physicians, called the high-risk pools funded in the bill “inadequate” and “simply a band-aid that does nothing to provide health security to the nearly one in three Americans who have a pre-existing condition.”

But Tom Price, secretary of the U.S. Department of Health and Human Services, called the vote “a victory for the American people.

“It is the first step toward a patient-centered healthcare system that will provide Americans access to quality, affordable healthcare coverage, empowering individuals and families to choose the coverage that best meets their needs…and equipping states to address the diverse needs of their most vulnerable populations,” Price said in a news release.

The bill is similar to one the House was set to vote on in March and which House Speaker Paul Ryan (R-Wisconsin) pulled at the last minute due to lack of support. The updated version includes an additional $8 billion for the state high-risk pools and some modifications in changes to Obamacare mandates.

Next: What happens now?

The Congressional Budget Office (CBO) estimated the earlier version of the bill would result in about 24 million people losing healthcare coverage over 10 years. The CBO has not yet “scored” the newer version.

The bill now goes to the Senate, where its prospects are considered uncertain. Republicans hold a 52-48 margin, not enough to overcome a filibuster, and experts say there is virtually no chance of any Democrats supporting the AHCA or any other changes to the existing law. “I don’t see that happening at all,” says Sally Pipes, president and CEO of the Pacific Institute and a healthcare adviser to former New York Mayor Rudolph Giuliani.

Moreover, Pipes says, the amount of money earmarked for state high-risk pools under the AHCA might produce opposition to the bill from some conservative Republican senators.