« AAFP Urges Congress... | Main | Reducing Administrat... »

Tuesday Jan 17, 2017

Speak Out to Preserve Health Care Coverage

On Friday, Donald Trump will be sworn in as the 45th President of the United States. Pursuant to our country's rich tradition, the transfer of power from the Obama Administration to the Trump Administration will take place in a peaceful manner.  

Upon being sworn-in as president, Trump and his administration will formally start working with the 115th Congress to pursue an ambitious domestic and foreign policy agenda. At the top of the domestic policy agenda is the repeal of the Patient Protection and Affordable Care Act (ACA).  During a press conference on Jan. 11, President-elect Trump provided his most concise perspective on the issue since winning the election.

"It will be repeal and replace," he said. "It will be various segments, you understand, but will most likely be on the same day or the same week, but probably the same day. Could be the same hour."

Setting aside how complicated repealing the ACA will be, the complexity of that process pales in comparison to replacing the law. Despite objections from a growing number of governors and congressional Republicans who are calling for a more thoughtful approach to repealing the law, Republican leadership and the Trump Administration are moving forward with repeal at an accelerated pace. The first wounds were inflicted last week.

On Jan. 12, the Senate approved a budget resolution for fiscal year 2017 that includes reconciliation instructions that will allow the Senate to repeal large parts of the ACA with a simple majority (51 votes). The House approved a similar resolution on Jan. 13, setting in motion a legislative process seeking to have a full repeal bill approved by the end of February.

In a Dec. 28 letter, the AAFP laid out its priorities with respect to how Congress and the new administration should proceed with health care reform. In that letter, the AAFP clearly stated that currently insured individuals should not lose their coverage due to any action or inaction by Congress or the administration. We also continue to stress the importance of impactful insurance reforms in current law that provide numerous protections for individuals, regardless of whether they have employer-sponsored insurance or purchase insurance through the individual market.  

In addition to our letter, we also joined with the American Academy of Pediatrics, the American College of Obstetricians and Gynecologists, and the American College of Physicians to communicate a set of principles regarding how Congress should approach their work.

I encourage you to lend your voice to this important debate by sharing how important health care coverage and insurance reforms are to your patients. Use the AAFP’s Speak Out to communicate with your members of Congress on this important issue. If you would like to stay closely connected to our ongoing work on this or any other issue, you should follow @AAFP and @rshawnm On Twitter.

The next few months will be quite busy in Washington, D.C. Here are the four items that will dominate the first 100 days of the Trump Administration:

  • cabinet nominations;
  • Supreme Court;
  • Affordable Care Act; and
  • Russia.

PQRS, ICD-10 and the Impact of AAFP Advocacy
On Jan. 9, CMS announced that it "will not apply the 2017 or 2018 downward payment adjustments, as applicable, to any individual eligible professional or group practice that fails to satisfactorily report for CY 2016 solely as a result of the impact of ICD-10 code updates on quality data reported for the fourth quarter of CY 2016."

This decision was made following an internal review because CMS determined that updates made to ICD-10 in October 2016 negatively impacted the agency's ability to process data.

This action is consistent with recommendations the AAFP provided to CMS in July 2015 regarding the implementation of ICD-10. At that time, the AAFP called for "additional appeals and agency monitoring for reporting systems that determine appropriate payment for medical services based on quality measures and meaningful use of electronic health records."

CMS is encouraging physicians to refer to the ICD-10 Code Updates message on the PQRS Spotlight webpage or the PQRS ICD-10 Section page for additional information.

AAFP News has an excellent summary about how this may impact your practice. We also have extensive resources on PQRS available for our members.

Wonk Hard
The issue of drug pricing has emerged as a concern for patients and payers. Although the headlines are dominated by the costs of new-to-market blockbuster drugs, the real impact is the escalating costs of existing products -- including generics -- for millions of patients who rely upon them for their health maintenance. Few things catch Washington, D.C., and Wall Street by surprise, but President-elect Trump did so on Jan. 12.

"(What) we have to do is create new bidding procedures for the drug industry, because they're getting away with murder. Pharma. Pharma has a lot of lobbies, a lot of lobbyists, a lot of power. And there's very little bidding on drugs. We're the largest buyer of drugs in the world. And yet we don't bid properly. We're going to start bidding. We're going to save billions of dollars over a period of time."

Stock values for pharmaceutical companies took an immediate hit, and patient advocacy organizations cheered. There is still plenty of work that will need to be done, but it looks like the Pharmaceutical Research and Manufacturers of America may need that $300 million they stockpiled for a Clinton Administration after all.

Comments:

Providers need to speak up!
Approximately a third of our clinic patients are covered by the ACA, if lost and not replaced we will be back to the days of Emergency Room visits for basic care. This would not be healthy or sustainable!

Posted by David Spiro on January 17, 2017 at 11:09 AM CST #

ACA is unconstitutional and not working. Repeal and Replace is the only way to go. The IQ of the current administration is pretty bad. Let's hope that the new guard will listen to other ideas and think outside the box. Solo FP here, no one has called me yet :)
Note to AAFP...whatever is the new proposal do not take a position and claim that the AAFP "represents" FP's throughout the country. The AAFP is not an elected representative body and so cannot go to DC as my representative. Just sayin'.....

Posted by Karl Hanson on January 17, 2017 at 11:22 AM CST #

The ACA has permitted my unemployed adult son who has a chronic illness to have health care insurance. I practice in a low income county where many people were uninsured prior to the ACA, despite working long hours at demanding jobs. Refusal to work together (insurers, state and federal legislators...) and a chaotic introduction resulted in a program that is admittedly not ideal. But you don't trash it, you fix it.

Posted by Virginia Johnson on January 17, 2017 at 12:21 PM CST #

Shawn,

Why so glum about the pending repeal of Obamacare? It is a terrible law. Give Trump and Congress the chance to present something that might actually work.

"The first wounds were inflicted last week." Is this your baby? Time to give it up.

Posted by Solo in Indiana on January 17, 2017 at 01:04 PM CST #

The ACA has its good and bad points. It has forced insurers to accept patients with preexisting conditions without penalty. It has allowed young adults to remain on their parents health insurance while they seek gainful employment hopefully with health insurance. It has allowed the self employed, artists, entrepreneurs, etc to be eligible for Medical Assistance. These people are often contributing to society but in a way that is not financial rewarding. It has allowed people to purchase health insurance independent of employment. It has eliminated lifetime caps. It has mandated that preventive care measures are covered for free and that no deductible applies. Vaccines are covered for free.

The ACA has failed in that it has allowed the health insurers to ratchet their premiums up to unaffordable levels. My health insurance for my family jumped 60% alone this year. We purchased (again) the cheapest plan on the market with a $6500 deductible per person (which also increased along with the premiums). The rates are unsustainable and even though many of my patients are insured, their deductibles make it impossible to even use their health plan. This was the plan by insurers all along (in my opinion). They just had to find a way to make everyone get insurance, which they had congress help them do.

We need to get health insurance companies out of the system. They are focused on profits. They are short sited in their views on patient's health and outcomes. They are not concerned about providing an efficient, comprehensive system that focuses on health. They focus on denying appropriate care and creating a middle layer to maximize profits.

Posted by Jennifer Hollywood on January 17, 2017 at 01:48 PM CST #

Shawn,

Your arguments and apparent support of the ACA leaves one with the impression that you and the AAFP crafted and want to maintain it. I may be wrong but the article appears to show a lesser concern for the constituents (FPs) than for advocating much needed changes to the ACA . One would think that the high fees we pay the academy are for giving a voice advocating in our support.

E. Villegas

Posted by E. Villegas on January 17, 2017 at 02:25 PM CST #

In response to 'Solo in Indiana' - not glum, simply mindful of the work that lies ahead on behalf of you, your colleagues, and your collective patients. Also, very cognizant of how difficult it is to actually repeal the law due to it relationship with several other laws and regulations. Repeal and Replace is a wonderful slogan, but the application of that two-step approach is actually extremely complicated. We are aggressively working to make the system better either inside the ACA or inside a new law. At the end of the day, my goal is to ensure that our health care system works for all patients, does not allow for discrimination in coverage or benefits and provides you the freedom and economic support to care for them.

The use of the phrase "The first wounds were inflicted last week" was designed to recognize that the law was damaged, but not dead - at that moment in time. Not my baby, but I hate to see it tossed out with the bathwater.

Posted by Shawn Martin on January 17, 2017 at 02:28 PM CST #

The lack of cap on lifetime benefits is one contributor to skyrocketing premiums. Also, paying 100% of preventive care benefits takes all motivation for cost containment out of the equation as providers/health systems know insurance companies have to cover everything preventive.
No car insurance allows you to replace your VW beetle with a Maserati, nor does homeowners insurance allow you to replace your 900 foot condo with Trump Tower. Yet this what health insurers are forced to do with policies under the ACA. This ACA was structurally flawed, some might say intentionally, to fail. It is a perfect example of a system designed to get exactly the result it is getting.

Procedures which are not covered by insurance have gotten less expensive over time--Lasik, for example.

I have hard working, every day patients paying cash for their hernia repairs, carpal tunnel surgeries, even colonoscopies and CT scans and getting great deals. If we de-regulate insurance, offer it (not mandate it) across state lines, and allow the market to work, we will see better care for less cost overall.

Politically, if we don't first REPEAL the ACA and get it off the books, it will be very difficult to get the two parties to work together toward anything that would replace it. The politicians might be more eager to pass a replace option if they knew that they were the ones responsible for blocking a REPLACE option if ACA had already been repealed. No one will blame them for stonewalling the repeal bill. But if it is repealed, the pressure will be on to do something better than the pre-ACA status quo.

Posted by David Usher on January 17, 2017 at 02:48 PM CST #

In response to 'Solo in Indiana' - not glum, simply mindful of the work that lies ahead on behalf of you, your colleagues, and your collective patients. Also, very cognizant of how difficult it is to actually repeal the law due to it relationship with several other laws and regulations. Repeal and Replace is a wonderful slogan, but the application of that two-step approach is actually extremely complicated. We are aggressively working to make the system better either inside the ACA or inside a new law. At the end of the day, my goal is to ensure that our health care system works for all patients, does not allow for discrimination in coverage or benefits and provides you the freedom and economic support to care for them.

The use of the phrase "The first wounds were inflicted last week" was designed to recognize that the law was damaged, but not dead - at that moment in time. Not my baby, but I hate to see it tossed out with the bathwater.

Posted by Shawn Martin on January 17, 2017 at 02:59 PM CST #

If I ever had any doubts that the AAFP was diametrically opposed to supporting actual FP doctors, those doubts are now erased by this article.

Posted by on January 17, 2017 at 04:31 PM CST #

The ACA pulled people out of the choppy seas of uninsurance, got them into the leaky boat of commercial insurance and US health care, and patched the biggest holes in the boat. Now they're complaining their feet are wet, and they have to bail.

Fixing the high cost of US health care will take a different plan. First you have to get everybody on board, not just most, then you have to provide truly comprehensive primary care, which nobody pays for today (unless you're in DPC.)

Next, when you combine social services and health care, the US spends about the same as other OECD countries. https://goo.gl/hkcdJW We spend ~half as much on social services, twice as much on health care. So we let people starve under bridges, then treat their pneumonia 2-3x/yr @ a cost of $20k a shot. Not very effective. Giving away subsistence support costs less than the health expenses it prevents. Being more compassionate saves money. Who'da thunk?

So 'fixing' US health care means doubling the amount we spend on feeding and housing people, closing down commercial insurance companies, paying more for better primary care, and giving primary care control over the rest of the health system.

I'm not holding my breath.

Posted by Peter J. Liepmann MD FAAFP on January 17, 2017 at 05:21 PM CST #

The ACA is NOT affordable and needs to be repealed asap!
The healthcare system turned the last few years into a disaster, severe nurse shortage and doctor shortage!!! The elderly Medicare patients are being treated very, very sadly with all the changes that went into effect these last few years.

We don't need 3000 pages of regulations and earmarks!
Just a few basic things need to change:
1.Patients should be able to choose, if they want to be insured
2. Insurances should not be allowed to cancel their contract, if the patient has a new, serious or chronic condition
3. Patients should be able to choose their doctors.
4. There should be a ceiling how much patients are being charged
5. Medical expenses should be much better tax deductible, the current law is a joke!
6. Doctors should NOT get "penalized" with the reimbursement, if patients are non-compliant for their own good reasons!

We need the competition of insurances, as much as more lenient regulations to encourage doctors to open up their own offices and disconnect from mega cooperation health care systems!

Posted by Alice Riedel on January 17, 2017 at 09:42 PM CST #

Shawn,
I'm intrigued to note that the "DISCONNECT" between working class Americans and the Government is also present between Physicians in the trenches and AAFP Administration authoring "IN THE TRENCHES". Health Care has significantly deteriorated in my area since ACA.

Posted by John Kilgallin MD on January 18, 2017 at 02:55 PM CST #

You must be logged in to post a comment. Login

About the Author



Shawn Martin, AAFP Senior Vice President of Advocacy, Practice Advancement and Policy.

Read author bio >>

Feeds

Archive Topics

Disclaimer

The opinions and views expressed here are those of the authors and do not necessarily represent or reflect the opinions and views of the American Academy of Family Physicians. This blog is not intended to provide medical, financial, or legal advice. All comments are moderated and will be removed if they violate our Terms of Use.