Like the previous Affordable Care Act (ACA) repeal-and-replace bills before it, the Graham-Cassidy Amendment fails to live up to the “First, Do No Harm” principle, AMA CEO and Executive Vice President James L. Madara, MD, wrote in a letter to Senate leaders.

Dr. Madara urged senators to vote against the measure, formally known as the Graham-Cassidy-Heller-Johnson Amendment to H.R. 1628, and to reject any legislation that “would jeopardize health insurance coverage for tens of millions of Americans.”

The bill Senators are considering would “result in millions of Americans losing their health insurance coverage, destabilize health insurance markets, and decrease access to affordable coverage and care,” Dr. Madara wrote.

Focus should be on stable premiums

Instead, he urged Congress to focus on stabilizing health insurance premiums in the individual marketplace by continuing to fund cost-sharing reduction payments.

The letter reiterated the AMA principles for health system reform. These include:

Any proposals to replace the current law should not result in individuals currently covered losing their insurance.

Key insurance reforms need to be maintained such as coverage for people with pre-existing conditions and parental coverage for young adults.

There must be guarantees that Medicaid, the Children’s Health Insurance Program (CHIP), and other safety-net programs are adequately funded.

At its annual meeting this past June, the AMA House of Delegates adopted a new policy declaring that “Our AMA opposes caps on federal Medicaid funding.”

“Capping Medicaid funding would be disastrous for patients, by limiting medical responses to unforeseen events and medical innovations,” Carl A. Sirio, MD, a member of the AMA Board of Trustees, said last June. “Physicians and states need the flexibility to respond. Caps would threaten coverage for vulnerable populations—especially children and those in need of a safety net—a point we have made repeatedly to policymakers in Washington.”

Dr. Madara repeated the AMA’s opposition to Medicaid caps and explained why the nation’s largest physician and medical student organization is against them.

“Per-capita-caps fail to take into account unanticipated costs of new medical innovations or the fiscal impact of public health epidemics, such as the crisis of opioid abuse currently ravaging our nation,” Dr. Madara wrote.

Related Coverage Federal funding for Medicaid program should not be capped: AMA

The bill would still require insurance companies to cover patients with pre-existing conditions, but it would also allow states to vary premiums based on health status. This could make insurance unaffordable for many.

Sens. Lamar Alexander, R-Tenn., and Patty Murray, D-Wash., held a series of Health, Education, Labor & Pensions Committee hearings this month seeking a bipartisan solution to stabilizing individual premiums and the health insurance marketplace. But published reports have stated that House Speaker Paul Ryan, R-Wis., and President Donald Trump are more interested in the Cassidy-Graham bill.

The Congressional Budget Office (CBO) announced it “is aiming to provide” a preliminary assessment of the measure’s impact on the federal budget deficit by early next week. But the CBO added that it won’t be able to provide estimates of the bill’s effects on health insurance or premium costs for several weeks.

In May, the CBO projected that the enacting H.R. 1628, also known as the American Health Care Act of 2017, would result in 23 million fewer Americans having health insurance by 2026. It projected that 22 million would become uninsured if a previous Senate bill, the Better Care Reconciliation Act, was adopted.

Coverage loss isn’t only concern

In addition to concerns over health insurance coverage, Dr. Madara explained in his letter the AMA’s objections to other provisions in the Graham-Cassidy bill, including eliminating the ACA’s Prevention and Public Health Fund after 2018.

The activities paid for by the fund “are key to controlling health care costs and the elimination of support for them runs counter to the goal of improving the health care system,” Dr. Madara wrote.

The AMA also objects to a provision in the bill that would prohibit individuals from using their Medicaid coverage to receive care at clinics operated by Planned Parenthood or similar organizations. Dr. Madara noted that this violates AMA policy on patient choice and physician freedom to practice in the setting they choose.

The measure’s main sponsors are Sens. Bill Cassidy, MD, R-La., and Lindsey Graham, R-S.C.

More information on the AMA’s position on the current reform bill and how physicians can take action can be found at the Patients Before Politics website.

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