On January 3, Republicans in the U.S. House of Representatives fired the first shot in the battle to replace the Affordable Care Act, in the form of their own legislation. The bill, known as the American Health Reform Act of 2017 would, among other provisions:
· allow healthcare insurance to be sold across state lines,
· increase the number of services which patients could pay for using health savings accounts (HSAs),
· make it more difficult to sue physicians for malpractice, and
· make federal money available to states to develop high-risk insurance pools for people with pre-existing conditions
The bill was introduced by Representative Philip Roe, a former physician who represents Tennessee’s First Congressional District. Roe, who co-chairs the GOP Doctors Caucus in the House of Representatives, introduced similar legislation in the last two sessions of Congress. Roe spoke with Medical Economics about the bill’s purpose, and why repealing the ACA is such a high priority for Republicans in Congress:
Medical Economics: How does this version of the bill differ from previous ones, if at all?
Roe: It does a little. We removed the 21st Century Cures part of the bill, because we’d already covered that by the law [of the same name] that was passed late last year. But otherwise it’s the same, and what we wanted to do was get this bill introduced to show people that we did have ideas and a bill out there ready to go.
Now, I certainly understand this bill won’t be the final version of what’s passed. I had lunch with the Speaker (Paul Ryan, Speaker of the House of Representatives) [on January 5], and basically we don’t know exactly what we can put in reconciliation yet. So whatever can go into reconciliation can come out of that bill. For instance, if you can put expansion of HSAs in there, there’s no need to have them in that bill.
Number two, once the new secretary of the U.S. Department Health and Human Services is approved by the Senate, then there are things he can do just by the stroke of the pen.
The idea was to put those principles out, and I will tell you that 80% of the bill—selling insurance across state lines, malpractice reform, transparency, I think docs will really appreciate.
I’ve said from the very beginning, the bill is amendable. I’m more than happy to listen to Democrat ideas. Because I think one of the problems with the first bill (the ACA) is that Republicans were closed out of it.
I think the real difference will be, do we add refundable tax credits in lieu of subsidies so that people can go out and purchase their health insurance on the open market, which has been essentially decimated by the ACA?
I wrote to governors asking them, if we had (healthcare) reform, how much of it would they like to do on the state level? The governor’s concern in Tennessee was pretty much the same concern we’ve heard about the (individual) mandate: the essential health benefits package is too restrictive.
ME: I’m sure you’re aware of the argument that the individual mandate is needed to get young, healthy people into the insurance pool so as to spread the risk around?
Roe: That was the theory. But look, there were 10.4 million people in the exchanges last year, and many of those didn’t get a subsidy. Almost as many people paid the penalty last year—eight million—as got a subsidy. So it isn’t working very well.