The latest GOP healthcare law being lobbied about is now known as the Graham-Cassidy bill, named after the Senators who devised this agenda. Included in this bill is the provision to turn over control of the healthcare system to individual states rather than being under the umbrella of the federal government. The Medicaid expansion would be halted and no more subsidies would be provided to states. A block of federal funds would be provided to each state and they would be free to devise the system they think best.
Additionally, under this bill, key components of the Affordable Care Act would be rolled back. While the legislators vow to protect patients suffering pre-existing medical conditions, they give power to states to determine how coverage will be administered. States would then be free to allow coverage to be reduced for certain services and medical conditions. In essence, pre-existing diseases would be covered in theory, but that coverage may be quite unavailable for many.
Much protest rings out about this bill, and not just based on political principles. Patient and doctor groups loudly voiced their opposition. The American Medical Association (AMA) issued the position statement that they oppose this bill largely because it violates the doctors’ oath of first doing no harm. Other large medical organizations expressed similar concerns.
Why is the Graham-Cassidy bill not the answer?
- It does nothing to discuss the fact that insurance coverage has largely become unaffordable due to large premiums and deductibles. Unless more competition is introduced into the marketplace, health insurance coverage will just become more and more unaffordable. Insurance companies are powerhouses with political sway holding a near monopoly over the sick and dying. When the ACA rolled out, it was hoped that more competition would make healthcare more affordable. What happened instead, was that a few big players offered a remixture of several plans without any significant competition and limited networks.
- Bringing the marketplace down to the state level brings it down to regulation by state governments. When the subsidies are cut back, it will be much harder to finance healthcare regulation and policy. Each state will have different policies in place. What happens when patients cross state lines?
- Funding to Medicaid will be cut. Over the last few years, Medicaid was expanding. Now, what will happen to these patients when the program is rolled backwards? Medicaid patients already are facing a crisis in terms of access as more and more doctors opt out of Medicaid. This will only get worse under the proposed bill and many of these patients will again be forced to use the emergency room as their primary care physician, driving up costs.
- Third parties will gain more power working at the state government level and be less accountable than are even now.
- Patients will be faced with even narrower networks. Deductibles and premiums will rise and many patients will drop their insurance. The problem of the uninsured will again intensify.
Facing outrage from public and medical groups alike, the bill being touted as an answer to needed healthcare reform is losing steam. While many politicians often fall into party lines, we are now seeing those standing up for the issues. Political careers will be made and destroyed by a bill that dictates more than 20% of the US economy.
While debate rages on, it is becoming clear that this is another doomed bill. There is little chance for success when it ignores what patients and doctors need to have a functional healthcare system. Patients simply want affordable and accessible healthcare. Doctors want to be able to provide our patients the best medical care with the least incumbrances. Until these facts are explored, legislation is doomed to fail at real reform and political posturing will reign DC.
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© 2017, Linda Girgis MD. All rights reserved.