The Affordable Care Act (ACA) reform legislation approved by the U.S. House of Representatives on May 4, 2017, by the narrow margin of 217 to 213 is expected to cause millions of Americans to lose their health insurance, make it much easier to eliminate essential health benefits and protections for people with preexisting conditions, and create instability for these protections in employer-sponsored health plans. Accordingly, ACEP’s Public Affairs team, working in conjunction with the Federal Government Affairs Committee and the Board of Directors, has shifted its focus to the Senate, where the fate of the American Health Care Act (AHCA) is much less certain.
Initial reactions by Republican senators have not been favorable to the AHCA, and not surprisingly, Democrats are unified in their opposition. Senate Majority Leader Mitch McConnell (R-KY) has the unenviable task of trying to craft a bill that can only lose the support of two Republicans from within a caucus of varying ideological beliefs about the ACA, its value to Americans, and whether it needs improvement or outright repeal. If Republicans fail to produce a plan that can be approved in the Senate and still have enough support to be passed in the House again within the next couple of months, the effort to modify the ACA, at least using the favorable procedural rules of budget reconciliation, will likely die.
On May 24, 2017, the Congressional Budget Office (CBO) released its updated analysis of the AHCA. According to the CBO estimate, the bill would result in 23 million more uninsured Americans over a decade while reducing the national deficit by $119 billion. Medicaid funding would be cut by $834 billion and cover 14 million fewer people. The AHCA repeals $664 billion in taxes and fees that currently finance the ACA. CBO also estimates that in states that do waive some of the “essential health benefits,” premiums would be 20 percent lower by 2026.
ACEP’s team has been meeting with key senators as they prepare their alternative to stress the importance of emergency medicine as an essential component of the nation’s health care system. Our message has been simple:
- Any bill the Senate produces must ensure patients have access to lifesaving emergency care.
- We want to constructively work with them to produce a bill that is consistent with ACEP’s Emergency Medicine Health Care Reform Principles (www.acepadvocacy.org/content.aspx?page=Issues).
- Americans overwhelmingly (95 percent) say health insurance companies should cover emergency medical care, and ACEP agrees with them.
- Patients must be able to receive emergency medical care when and where it is needed, without seeking preauthorization or fearing that their insurance company will only cover services based on the final diagnosis and not the presenting symptoms.
In addition to our direct meetings with lawmakers on Capitol Hill, we have also used opportunities provided by NEMPAC to attend fundraisers, sent action alerts from ACEP members, and facilitated member visits with senators back home to share our vision for health care reform. We further intend to supplement these actions through the Leaders Visit program when ACEP President Rebecca Parker, MD, FACEP, travels to Washington, D.C., to meet with key senators in June.
On a related matter, the Trump administration, through the Department of Health and Human Services and the Centers for Medicare & Medicaid Services (CMS), has been placing a great deal of emphasis on state Medicaid waivers. In fact, CMS is actively promoting waivers and has provided guidance to states as to how to go about applying for them. We are working to ensure the federal Prudent Layperson Standard is not eroded through this process and that emergency medicine patients remain protected from predatory practices. Waivers will continue to be the topic of discussion now and for the foreseeable future by ACEP’s Board of Directors, the Federal Government Affairs Committee, the State Legislative/Regulatory Committee, and the Emergency Medicine Action Fund.
Dr. Norse is chair of ACEP’s Federal Government Affairs Committee, associate professor in the department of emergency medicine at the University of Florida College of Medicine–Jacksonville, and medical director of the Emergency Medicine Clinical Center.