Major players remain opposed to ACA replacement ahead of House vote

The American Medical Association (AMA), the American College of Physicians (ACP) and the American Academy of Family Physicians (AAFP) have all come out against passage of the American Health Care Act (AHCA), the Republican-sponsored plan to replace the Affordable Care Act (ACA), which is scheduled for a vote before the full House of Representatives on March 23.

The vote will come 17 days after the legislation was introduced, compared to the 116 days that elapsed while the ACA went through the same process. After a mostly negative report from the Congressional Budget Office (CBO) said the AHCA would eventually reduce premiums while resulting in 24 million fewer people being insured, amendments were introduced aimed at bolstering support among Republican members.

Those changes, which include $85 billion in extra tax credits for older customers and letting state establish work requirements for Medicaid, haven’t swayed medical groups that came out against the original bill. ACP said the amendments actually made the bill worse.

“Our Ethics, Professionalism and Human Rights Committee has stated that it is contrary to the medical profession’s commitment to patient advocacy to accept punitive measures, such as work requirements, that would deny access to coverage for people who need it,” wrote ACP President Nitin Damle, MD, MS.

ACP’s senior vice president of government affairs, Bob Doherty, went further on Twitter, writing that the bill “has to be stopped” and he’s “never seen a bill which would do more than to health” than the AHCA.

The changes did appear to please health insurers. The industry’s largest lobby, America’s Health Insurance Plans (AHIP), said the legislation includes “essential steps for stabilizing the individual market,” but stopped short of a full endorsement.

Though no updated CBO report was released on the amended bill, the Brookings Institution estimated the changes would “not meaningfully alter” the projection of a 24 million-person reduction in insurance coverage.

The AMA, already devoting a website to opposing the AHCA, reiterated its stance to a letter to congressional leaders after the amendments were released.

“The need to stabilize the individual insurance market and make other improvements in the Affordable Care Act is well understood,” wrote AMA CEO James Madara, MD. “However, as physicians, we also know that individuals who lack health insurance coverage live sicker and die younger than those with adequate coverage. We encourage all members of Congress to engage in an inclusive and thorough dialogue on appropriate remedies. We cannot, however, support legislation that would leave health insurance coverage further out of reach for millions of Americans.”

AAFP Board Chair Wanda Filer, MD, MBA, expressed similar concerns in her own opposition letter.

The bill’s passage is far from certain. Despite a visit from President Donald Trump on March 21, the conservative House Freedom Caucus has said 25 members are planning to vote against it, according to POLITICO, above the 22 Republican “nos” needed to kill the bill. The odds are even longer in the Senate, where Republicans can lose only two votes. Democratic vote counter, Sen. Dick Durbin, D-Illinois, told HealthExec no one from his caucus, even those from states Trump won in the presidential election, would vote for the bill.

Despite those internal vote counts, the Trump administration has remained optimistic.

“There’s plan A and plan A,” said White House Press Secretary Sean Spicer. “We're going to get this done. If you want to see Obamacare repealed and replaced, this is it. This is the vote.”