Leaders representing more than 560,000 physicians and medical students gathered on Capitol Hill Wednesday to lobby senators to reject the Better Care Reconciliation Act (BCRA), which was proposed last week to replace the Affordable Care Act (ACA).
The visit to the Hill followed opposition voiced by publications such as the New England Journal of Medicine, which said in an editorial published on June 27, that rather than improving healthcare, the BCRA “will reduce the number of people with health insurance by about 22 million, raise insurance costs for millions more, and give states the option to allow insurers to omit coverage for many critical health care services.”
On Wednesday, the physician group leaders spoke with reporters about the potential harm they see in each of their specialties.
Phaseout of Subsidies
Jack S. Ende, MD, president of the American College of Physicians, said many patients will delay or forgo care without the same level of federal subsidies gained under the ACA to help pay premiums and deductibles.
He noted that BCRA reduces eligibility for subsidies from 400% of the federal poverty level to 350%.
“Moreover, after 2 years it will completely repeal cost sharing reductions resulting in higher deductibles and copayments for older, sicker and poorer patients. Under BCRA, in 2026 a person earning, for example, $11,400 a year would have a deductible that is more than half their annual income,” Dr Ende said.
The new bill also leaves definition of essential health benefits up to states.
Michael Munger, MD, president of the American Academy of Family Physicians, said that means the bill represents a threat to people with chronic health conditions.
“Without access to essential benefits that can help them manage their chronic illnesses, these patients can be crippled by asthma or complications of diabetes,” he said. “Cancer or heart disease can become a death sentence.”
Fernando Stein, MD, president of the American Academy of Pediatrics, said if the bill passes in its current form, “there is a potential body count associated with this law.”
He pointed to the 37 million children who rely on Medicaid, including those with special needs and those in low-income families. The Senate bill would phase out Medicaid expansion over 3 years, beginning in 2021. It would also start per-capita limits on coverage and reduce coverage overall by $772 billion by 2026, according to the Congressional Budget Office.
Haywood L. Brown, MD, president of the American College of Obstetricians and Gynecologists, said the legislation represents “an assault on women’s health.”
The proposal could take Americans back to a time when men and women paid differently for their insurance and “when having a baby could lead to bankruptcy and being a cancer survivor could put coverage out of reach,” he said.
At the same time that 50% of pregnancies are unplanned, he noted, the bill would end guaranteed coverage of maternity care and preventive services, including contraception.
“This threatens to hamper our efforts to reduce maternal mortality where the United States ranks in the high-40s in developed nations and reverse unintended pregnancy rates, particularly among adolescents,” Dr Brown said.
Mental Health Help at Risk
The bill’s phaseout of Medicaid expansion also comes as opioid misuse and addiction is rising in every state.
Renee Binder, MD, past president of the American Psychiatric Association, pointed out that the expansion helped get treatment for 2.8 million Americans with substance abuse disorders and 1.6 million people with serious mental illness.
Also, health plans currently have to cover preventive services, such as depression, alcohol, and drug use screenings. But if states can define essential benefits, those service would no longer be guaranteed.
“There is no healthcare without mental healthcare,” she said.
Boyd R. Buser, DO, president of the American Osteopathic Association, argued that the bill takes the wrong approach financially.
Rather than reducing healthcare costs, it focuses on reducing federal spending by decreasing coverage and eliminating policies that ease access to preventive care “that can drive down expenses while improving outcomes,” he said.
Talks Resume After Recess
Debate on the bill has been postponed until after the Senate’s Fourth of July recess.
The physician leaders said they would spend the time until then delivering calls to action to their members and to patients, urging them to convey their messages to their senators.
The speakers have disclosed no relevant financial relationships.
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