‘Will­ing to take the hits’ for speak­ing out against the GOP re­peal bill

Modern Healthcare - - Q & A -

“His­tor­i­cally, al­most ev­ery ac­tion re­lated to health­care has been to ex­pand ac­cess. . . . I’ve never seen leg­is­la­tion get this far to take ac­cess away.”

Robert Do­herty, the long-time chief lob­by­ist of the Amer­i­can Col­lege of Physi­cians, has drawn at­ten­tion for his out­spo­ken crit­i­cism of the House Repub­li­can leg­is­la­tion to re­peal and re­place the Af­ford­able Care Act.

Do­herty is se­nior vice pres­i­dent for gov­ern­ment af­fairs at the Philadel­phia-based ACP, which rep­re­sents 148,000 in­ternists and in­ter­nal med­i­cal sub­spe­cial­ists. He spoke with Mod­ern Health­care se­nior re­porter Har­ris Meyer on May 4, min­utes af­ter the House passed the Amer­i­can Health Care Act, or AHCA. He de­scribed his or­ga­ni­za­tion’s ob­jec­tions to the House bill and its plans to lobby the Sen­ate to pre­serve the ACA’s in­sur­ance cov­er­age ex­pan­sions. The fol­low­ing is an edited tran­script.

Mod­ern Health­care: What’s your im­me­di­ate re­sponse to the House pas­sage of the AHCA?

Robert Do­herty: It’s pre­ma­ture for the Repub­li­cans to take a vic­tory lap on their health­care bill. It’s not a vic­tory for pa­tients at all. It rolls back cov­er­age for mil­lions of peo­ple. Get­ting leg­is­la­tion like this through the Sen­ate will be tough sled­ding.

House Repub­li­cans dis­re­garded views of physi­cians, nurses and other front-line providers to pass this ter­ri­ble leg­is­la­tion. We have sent a let­ter to sen­a­tors ask­ing them to put aside this flawed bill and start over on bi­par­ti­san re­forms to im­prove rather than harm pa­tient care.

MH: Did you try to work with House Repub­li­cans on the bill?

Do­herty: Go­ing back to Jan­uary, we said we’d love to have a con­ver­sa­tion about im­prov­ing the ACA, which is not a per­fect bill by any means. We got no re­sponse. There was ab­so­lutely no ef­fort to en­gage with us and other groups rep­re­sent­ing front-line clin­i­cians. The Repub­li­cans were so dead­set on re­peal­ing the ACA that they weren’t will­ing to have a con­ver­sa­tion about im­prov­ing it.

MH: What are the AHCA pro­vi­sions that most con­cern your or­ga­ni­za­tion?

Do­herty: It’s hard to tease out one be­cause the whole bill is so aw­ful for pa­tient care. At the top of the list is the dam­age it does to Med­i­caid. If the feds cut their con­tri­bu­tion by 25%, the only way states can make up for that is by re­duc­ing el­i­gi­bil­ity and ben­e­fits, rais­ing taxes, cut­ting provider pay­ments or cut­ting other pro­grams.

The bill also phases out the Med­i­caid ex­pan­sion. With­out the higher fed­eral con­tri­bu­tion, the vast ma­jor­ity of ex­pan­sion states will have no choice but to end the pro­gram. That’s un­ac­cept­able.

It guts the ACA’s con­sumer pro­tec­tions in terms of pre-ex­ist­ing con­di­tions and es­sen­tial health ben­e­fits. In­sur­ers might no longer be re­quired to cover chemo­ther­apy or child­birth or sub­stance abuse treat­ment or physi­cian and hospi­tal vis­its or pre­scrip­tion drugs. In­sur­ers could base pre­mi­ums on pre­ex­ist­ing con­di­tions, and that would make cov­er­age un­af­ford­able.

The bill pro­vides some fund­ing that states could use for high-risk pools, but all the anal­y­sis we’ve seen is that the dol­lars don’t come close to pro­vid­ing af­ford­able cov­er­age for those with pre­ex­ist­ing con­di­tions.

The bill re­places in­come­based premium and cost-shar­ing sub­si­dies with age-based ones. It’s less help­ful to low-in­come peo­ple and more help­ful to high-in­come peo­ple, and poorer peo­ple are the ones who most need the help. When you com­bine that with al­low­ing in­sur­ers to charge older peo­ple five times more rather than three times more, it will make pre­mi­ums and de­ductibles much more un­af­ford­able.

MH: What are the prospects for Sen­ate pas­sage of the House bill?

Do­herty: Quite a few Repub­li­can sen­a­tors have

gone on record say­ing they have sub­stan­tial con­cerns about the House bill. You’ll see par­tic­u­lar con­cerns among sen­a­tors from Med­i­caid ex­pan­sion states who don’t want the ex­pan­sion money cut off.

Quite a few Repub­li­cans are re­cep­tive to a di­a­logue on how to fix the ACA rather than throw­ing it out. Those are the folks we’ll try to ad­dress.

MH: What are the chances of Sen­ate Repub­li­cans work­ing with Democrats on a bill?

Do­herty: They’ll start out try­ing to do it through bud­get rec­on­cil­i­a­tion, with­out any Demo­cratic votes, but they’re go­ing to face pro­ce­du­ral prob­lems be­cause un­der rec­on­cil­i­a­tion, pro­vi­sions must have a di­rect im­pact on fed­eral spend­ing, and some of the House pro­vi­sions on pre-ex­ist­ing con­di­tions and es­sen­tial health ben­e­fits may well be ruled out by the Sen­ate par­lia­men­tar­ian un­der rec­on­cil­i­a­tion.

If Sen­ate Repub­li­cans can’t get 51 sen­a­tors to vote for their rec­on­cil­i­a­tion bill, they’ll have no al­ter­na­tive other than to reach out to Democrats, or else they’ll have to let the whole ef­fort fal­ter.

MH: Is the ACP con­cerned that its strong po­si­tion on the House GOP bill could anger the Trump ad­min­is­tra­tion and con­gres­sional Repub­li­cans and hurt its ef­forts in other ar­eas?

Do­herty: Ob­vi­ously, we all weigh that if you take a firm stance against what the cur­rent ad­min­is­tra­tion and cur­rent con­gres­sional lead­er­ship want to do, there can be ad­verse con­se­quences for your or­ga­ni­za­tion on other is­sues. The physi­cian lead­er­ship of ACP made it very clear that rolling back cov­er­age for mil­lions of peo­ple is wrong on its mer­its and wrong morally. They’ve been very sup­port­ive of the firm stance we’ve taken. We’re will­ing to take the hits that come with that.

It doesn’t mean that we can’t work with the ad­min­is­tra­tion on other is­sues. We’re al­ready hav­ing side con­ver­sa­tions on elec­tronic health records and other is­sues that are very pro­duc­tive.

MH: Do you see any­thing unique about this Repub­li­can re­peal-and-re­place ef­fort?

Do­herty: In my 38 years of ad­vo­cat­ing for physi­cians and pa­tients, I’ve never seen a bill that would do more harm than this one. His­tor­i­cally, al­most ev­ery ac­tion re­lat­ing to health­care has been to ex­pand ac­cess, such as Medi­care, Med­i­caid, CHIP and the ACA. I’ve never seen leg­is­la­tion get this far to take ac­cess and cov­er­age away from peo­ple.

MH: Do you ex­pect Repub­li­cans to face po­lit­i­cal reper­cus­sions?

Do­herty: I ex­pect there will be po­lit­i­cal con­se­quences. If you start tak­ing cov­er­age away from peo­ple, such as chil­dren with heart de­fects, those stories get known and there will be tremen­dous back­lash. The Repub­li­cans who voted for this will get an ear­ful, and they should.

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