With millions of Americans’ health insurance coverage on the line, it is important for members of Congress to work together in a bipartisan way to ensure that whatever replacement or repair of the Affordable Care Act (ACA) is presented does not harm the public, Democratic Sen. Ron Wyden, and Congressmen said last week to physicians attending the AMA National Advocacy Conference in Washington, D.C.
“At some point, if you’re going to replace the [ACA] in a way that doesn’t hurt people, you’ve got to make the math of how you’re going to pay for the replacement add up,” said Wyden, ranking member of the Senate Finance Committee, which has jurisdiction over Medicare and Medicaid.
“What is particularly problematic is that the most recent effort would create loopholes in the [ACA] that would disproportionately hurt those Americans with preexisting conditions,” he said.
“I believe rural America is going to get clobbered by some of these changes in the ACA,” the senator said.
In rural America, there is a very large elderly population which requires care for chronic disease and multiple comorbidities “and Medicaid expansion has been enormously important to them,” Wyden said. “It has been a lifeline and in many ways without rural health care you can’t have rural life.”
“We’re all for flexibility, but all the flexibility in the world isn’t going to get people covered if you don’t have the dollars,” Wyden added. “To get lasting solutions you need bipartisanship. In other words, you can probably drive something through … if you control all the branches of government [and] you’ve got all the gavels in your hand. But if you want to get a lasting solution, you need real bipartisanship.”
Rep. Joseph Crowley, D-N.Y., said that bipartisanship is indeed critical, as shown in areas such as the Medicare Access and CHIP Reauthorization Act (MACRA) and the sustainable growth rate (SGR).
“There certainly have been past examples of bipartisan work on health care,” he said. “The MACRA law was passed in replacement of the SGR formula. We all agree on a bipartisan basis that the SGR system was deeply flawed.”
“And after years of patches and delays and kicking the can down the road, I was genuinely proud to see us come together to fix it once and for all,” Crowley said. “This was a bipartisan effort that shifted paying for volume to paying for value. Now, that’s an important message to send to our health care system.”
Health care “happy talk”
The debate over the ACA is still very fluid. Throughout the week, physicians from across the nation visited their members of Congress on Capitol Hill to offer their insights and aid those members in the debate.
“Talk to your members about your priorities,” Wyden said. “You have been there in terms of making sure, for example, that Medicaid expansion and care for the vulnerable is done right. You have made it clear that you want to look for ways to generate efficiencies while meeting the quality needs of the people. That’s what the quality effort and finally bringing about the retirement of SGR was all about. I thank you for that.”
“When people are threatened with losing coverage … they don’t want a bunch of happy talk,” he explained. “They want to hear about real solutions.”
Physician priorities on issues such as standing up for the poor, a new payment system, rewarding quality and working upstream to prevent illness “were not health care ‘happy talk’,” Wyden said. “Thank you for speaking out and being up on the Hill.”
One of the most important components of care for physicians is patient education, said Sen. John Barrasso, MD, R-Wyo., an orthopedic surgeon and winner of the 2017 Dr. Nathan Davis Award for Outstanding U.S. Senator. He was honored for his leadership in repealing the Sustainable Growth Rate formula and for shaping the new Medicare payment system, the Quality Payment Program.
“We are advocates for patients; we are also teachers for patients,” Dr. Barrasso said. “The more we can do that, the better.”
What everyone wants for the elderly, their parents, are safety and comfort, Dr. Barrasso said. “What we want for ourselves is autonomy to make our own decisions. So as physicians, we work in between that area of people who want freedom, but at the same time wanting to perfect our patients.”
What stays?
“Repeal, replace, reform, retain, rescue. You hear all kinds of ‘R’ words out there,” said Rep. Charlie Dent, R-Pa. “I certainly agree that change is essential; it’s necessary. I believe the rhetoric surrounding health care law has created a tremendous challenge in finding real solutions.”
“I often feel like there’s a lot of messaging going on without enough policy substance to back it up,” he said. “There’s some on the far right calling for immediate and full repeal, without a viable replacement alternative. Others on the far left aren’t willing to entertain any changes and frankly aren’t acknowledging any problems.”
Dent said there are some parts of the ACA that need to be repealed, parts that should be replaced, yet there are some that should be retained. “Any repeal bill should be accompanied by a viable replacement-and-reform plan that ensures stability of the health care marketplace and minimizes any disruptions in coverage to America’s citizens and patients.”
“In my eyes, the areas where the ACA succeeded were its protection for people with preexisting conditions or illnesses and allowing young adults to remain on their parents’ plans until the age of 26,” Dent said.
And Rep. Kevin Brady, R-Texas, agreed that those provisions must remain. “We have to make sure those common-sense patient protections are in place,” he said. “We [also] want to make sure there is not a lifetime cap on your medical benefits.”
Restoring and reestablishing the patient-physician relationship is a priority, Brady said. “The question is: How do we move forward and advance 21st-century health care that is personalized to individuals? That gives them the opportunity to tailor their health care to their needs, not Washington’s? And as AMA continues to point out so rightly, [care that] deliver[s] on patient-focused health care reform for all Americans?”
