After House Republicans rolled out their plan to replace and repeal the Affordable Care Act with a bill titled the American Health Care Act, responses from the health care community ranged from cautious optimism to downright disgust.
Since its introduction, the GOP’s plan has faced opposition from health care groups including the American Medical Association, American Academy of Family Physicians, the American Academy of Pediatrics, American Nurses Association and the American Hospital Association.
Dr. Peter Liebert, a pediatric surgeon practicing in Westchester and Fairfield counties, has coined a nickname for the proposed legislation, one he hopes will catch on.
“There was Obamacare or Affordable Care,” Liebert said. “This will be the Disaster Care Act.”
Liebert said that if the bill passes, the implications would be “tremendously negative.”
“Why the Republican leaders in the House would put through a bill like this is beyond me,” he said. “This is not something that’s appropriate, and if they feel they have to do something, they should do something with deliberation, with thought, and consult the health care community, which it doesn’t look to me as if they have.”
That sentiment was shared by Dr. Robert G. Lerner, a professor at New York Medical College and chief of hematology at Westchester Medical Center, who said the bill would be “devastatingly terrible” for patients.
“I don’t think it’s going to pass, certainly not in its current form,” Lerner said. “That’s impossible. If it’s very heavily altered, it’s plausible that it could pass, but then again, I don’t know.”
For some physicians, like Dr. Gino Bottino, a hematology and oncology specialist at Northern Westchester Hospital in Mount Kisco, it is still far too early to make a judgment on the AHCA.
“It seems to be a plan in its infancy that will be changed by committee as it goes through the process,” said Bottino, who is also president of the Westchester Medical Society. “So what the plan ends up being and what it is now may not be the same things.”
While the Westchester Medical Society voiced its opposition to the Affordable Care Act in 2009, the group has not taken a stand on the American Health Care Act.
“I think the middle class has gotten hurt by the ACA. I think that their premiums went up a lot and their donut holes went up a lot and they lost coverage,” Bottino said. “But I don’t know that the (Paul) Ryan plan is going to restore that.”
According to Gov. Andrew Cuomo’s office, repealing the ACA would result in 2.7 million New Yorkers losing health care coverage and a $3.7 billion hole in the state’s budget.
“It gives us a lot of concern,” said Kevin Dahill, president and CEO of the Nassau-Suffolk Hospital Council and the Northern Metropolitan Hospital Association, two hospital-advocacy organizations that comprise the Suburban Health Care Alliance. “It’s an issue not just about these people losing their coverage but the state losing its money. The effect on the New York state economy concerns us.”
The GOP plan would do away with the ACA’s individual mandate requiring people to have health insurance or face fines.
“I think it’s clear that this will lead to more people not having insurance,” said Lindsay Farrell, president and CEO of Ossining-based Open Door Family Medical Centers.
The Congressional Budget Office, which released its report on the American Health Care Act on March 13, estimates that 14 million more people would be uninsured by next year as a result of the Republican health care bill. That figure would rise to 24 million by 2026.
“Many people who can’t afford health insurance won’t have health care,” Liebert said. “It’s just that simple.”
Many health care providers believe that the American Health Care Act will drive more patients to emergency rooms, which are often overcrowded and deliver more expensive services.
“When you don’t have insurance, you postpone getting care and you wait until you get sicker. You don’t get preventive screening, which leads to detecting illness in its later stages,” Farrell said. “If you don’t have insurance, you’re not going to do the cancer screenings and the wellness visits. Why would you?”
Added Dahill, “These people will still come to the hospital, but they’ll come to the emergency rooms because now they won’t have access to primary care, so we’ll be back to where we started in that regard.”
Another glaring concern for medical professionals is the plan’s sweeping changes to Medicaid and a proposed restructuring of its funding, which Republicans assert is “not sustainable in its current condition.” Under the Republican House proposal, the new law would phase out the expansion of Medicaid included in the ACA, though those now in the program would not lose their coverage.
“Over the course of the last six years that the New York state exchange has been up and running, the state has provided new coverage to 3 million people. About 2.3 million of that 3 million qualified for Medicaid,” Dahill said. “So we’re very concerned people could lose their coverage.”
Additionally, the plan proposes capping payments to states per Medicaid enrollee, rather than administering Medicaid at the federal level. “The retraction of Medicaid funding would be just disastrous for hospitals,” Farrell said.
Dr. Mark E. Geller, president and CEO of Nyack Hospital, said the AHCA would “significantly impact the ability of hospitals and health care systems to provide care” for patients. “The new plan maintains the cuts to Medicare and federal Medicaid levied on hospitals and health systems by the Affordable Care Act without remedying coverage discrepancies,” he said.
Health care professionals also noted that while New York is very committed to its Medicaid program, other areas of the country may not fare so well.
“I consider myself really lucky to be doing this work in New York, because compared to my colleagues across the country, we’ve had real health care leadership in the state, so that’s a good thing if you’re on the health care delivery side,” Farrell said.
Liebert agreed that New York, as well as Connecticut, will likely ensure that adequate care is given to low-income patients, though he couldn’t say the say for some of the country’s more rural areas.
“It’s wrong,” Liebert said. “These people deserve adequate care. I can imagine that in rural Louisiana or Mississippi, these people won’t have any kind of health care coverage at all, and I don’t know where they will get it.”
Additionally, the Republican plan calls for the elimination of cost-sharing subsidies available under the ACA. The proposed AHCA would instead offer tax credits that, unlike the ACA, would be determined by age, not income.
“So if you’re older, you’re going to get more,” said Farrell, “but the insurance companies will be allowed to charge you five times as much for the coverage, so it does seem like it’s going to put a real burden on the elderly.”
Medical professionals also questioned the efficacy of tax credits as opposed to subsidies.
“That’s money that you see way down the line that’s not going to help you if your pocketbook is a bit strained,” Farrell said.
Dahill said that many who received health insurance for the first time under the ACA did so because they were only able to afford premiums thanks to subsidies. “The notion of a refund tax credit, although there’s some incentive there, for that category of person and family, we don’t think is going to work,” he said.
For families aiming to balance their budgets, Dahill added, waiting until tax time to receive a credit is “not going to cut it.”
“We are very apprehensive that a lot of people are going to opt out of coverage as a result of this and then we’re going to be back to where we started eight years ago,” he said. “It becomes a step backwards.”
Providers are also unsure how the proposed legislation would affect smaller-sized hospitals and practices.
Lerner said the potential rising costs of care as a result of the AHCA could shift to individual health systems and could even drive some to bankruptcy.
“We can lose additional hospitals if their budget is decimated by this legislation,” he said.
However, Bottino was optimistic that health care reform will assist in allowing single practitioners and smaller groups of physicians to remain in practice.
“Under the ACA, it became next to impossible to practice medicine because the mandates and the requirements became so overwhelming and costly that people couldn’t do it anymore,” he said. “It pushed doctors from being mostly in small, private practices to being mostly owned by corporations.”
Bottino also points to the ACA as the driving force behind the consolidation of large medical systems into “huge corporate entities.”
“These consolidations seem to have hurt everybody, so we would like to see a way that would promote competition in the health system,” he said.
Dahill, who recently returned from a meeting with leaders in the health care field and Republican Congressional representatives, said he believes that after the bill was advanced through two key committees, some legislators are “starting to think this (bill) through.”
“There are a few of them that are going to support this no matter what, but there are several who are hearing what we’re saying, hearing what the physicians are saying and what their individual constituents are saying,” he said, “and I think they’re getting a little bit of cold feet.”