ACR Joins Opposition to Proposed Healthcare Replacement Bill as Written

The ACR is joining a chorus of voices asking Congress to reconsider several key provisions in the proposed American Health Care Act (AHCA) that it feels could have a detrimental effect on patients.

Characterized as a replacement to the Affordable Care Act (ACA), the AHCA eliminates a number of provisions found in the ACA, although it does retain some of the ACA’s most popular provisions.

 Major Concern: Access to Care
Like other medical groups, the ACR is glad to see several of the ACA’s most popular provisions are not repealed by the AHCA, such as no exclusions for coverage based on pre-existing conditions and coverage for children up to age 26 on their parents’ insurance.

“We are concerned that some provisions of the AHCA could make it harder for our patients to access rheumatology care,” said Sharad Lakhanpal, MBBS, MD, president of the ACR, in a statement issued on March 9.¹

These provisions include replacing income-based subsidies under the ACA with fixed tax credits based on age rather than income, as well as imposing a 30% penalty on premiums for patients who lose coverage for more than 63 days.

Other Concerns: Access to Medication, Capping Medicaid
Expanding on those concerns, Angus Worthing, MD, chair of the ACR’s Government Affairs Committee, underscored that many patients under the proposed replacement bill could lose access to lifesaving and life-altering drugs, such as biologics. “These are virtually unaffordable without insurance,” he says.

Dr. Worthing also highlights concerns expressed by pediatric rheumatologists that the proposed bill would remove federal guarantees for Medicaid payments. Under the AHCA, states would be given a set amount of money per person (per capita cap) to spend on Medicaid recipients starting in 2020; this amount would grow yearly to account for inflation.

However, setting a cap on Medicaid dollars under such a formula is problematic. “Healthcare costs may increase faster than the proposed per capita Medicaid funding and leave poor children and families without coverage,” says Dr. Worthing.

Physician & Patient Groups Weigh In
In addition to the ACR, other medical groups have expressed concerns, including the American Medical Association (AMA), the American Hospital Association, the American College of Physicians (ACP), the American Association of Retired Persons (AARP) and most medical specialty groups.

In a statement issued on March 8, the AMA also highlighted concerns over the use of tax credits based on age rather than income for obtaining private health insurance coverage, as well as changes to Medicaid that could limit states’ ability to adequately cover low-income families, for example, changes to services needed for chronic conditions, such as mental health and substance abuse, as well as ongoing problems, such as opioid abuse and addiction.^{2, 3}