The changes made to the American Health Care Act (AHCA), the Republican-sponsored legislation to replace the Affordable Care Act (ACA), have only strengthened opposition to the bill from groups representing hospitals, internists and emergency physicians.
The amended version of the bill which failed to garner enough Republican support to pass the House in March centers on state waivers to the ACA’s insurance requirements. As long as states can demonstrate easing these requirements will lower premiums—an easy hurdle, considering skimpier coverage would be less expensive—HHS will grant waivers on the ACA’s essential health benefits and allowing individual ratings based on a customer’s medical history and health behaviors.
Slashing benefits could mean plans don’t cover hospitalization, which drew the opposition of the American Hospital Association (AHA).
“The amendment proposed this week would dramatically worsen the bill,” AHA President and CEO Rick Pollack said in a statement.
Emergency services could be also be excluded from insurance coverage, leading to the American College of Emergency Physicians (ACEP) calling on lawmakers, either in the House or Senate, to reinstate those benefits.
“The Affordable Care Act included emergency services as an essential health benefit and any replacement legislation must do the same,” said ACEP President Rebecca Parker, MD. “Patients can't choose where and when they will need emergency care and they shouldn't be punished financially for having emergencies."
Similar opposition came from the American Medical Association, which said the waiver policy would make the ban on insurers denying coverage based on pre-existing conditions “illusory." America’s Essential Hospitals, a coalition of public hospitals, said the changes could add to the AHCA’s original projections of 24 million more uninsured, calling it “simply bad policy.”
The American College of Physicians (ACP) has been especially outspoken about the new bill, opposing it before the amendments were fully introduced. The waiver options would return the insurance market to the “pre-ACA days,” according to ACP President Jack Ende, MD, who went to suggest the AHCA needs to be scrapped altogether.
“We urge Congress to instead start over and seek agreement on bipartisan ways to improve and build on the ACA,” Ende said.
Despite the industry’s opposition, the Trump administration is predicting a House vote on the bill by May 3.
“Do we have the votes for healthcare? I think we do,” President Donald Trump’s top economic adviser, Gary Cohn, told CBS. “This is going to be a great week. We're going to get healthcare down to the floor of the House, we're convinced we've got the votes, and we're going to keep moving on with our agenda.”