AOA President Boyd R. Buser, DO, issued the following statement today in a letter to House Speaker Paul Ryan, Senate Majority Leader Mitch McConnell, House Minority Leader Nancy Pelosi, and Senate Minority Leader Charles Schumer:
“Since its release early last week, the American Osteopathic Association (AOA) has given the American Health Care Act (AHCA) careful consideration to assess how it might impact the AOA’s Priorities for Health Care Reform shared at the start of the new Congress. Our initial concerns were strengthened with the release today of the legislation’s long-awaited score by the Congressional Budget Office (CBO) that estimates should the AHCA become law, an additional 24 million Americans will lack coverage by 2026. We therefore write to you now to state that we are unable to support the legislation as written, and urge you to reconsider advancing it any further through the legislative process.
The AOA, a physician association advocating for nearly 130,000 osteopathic physicians and medical students, recognizes the many challenges our current health care system faces and is supportive of efforts to improve it. But we feel that the American Health Care Act falls far short of representing such improvements, and would in fact actually exacerbate its current shortcomings if passed into law as written. Rising health care costs are a more immediate basis for current difficulties in ensuring access to affordable, high quality care to all Americans, and this legislation does nothing to address them or further bend the cost curve.
We are pleased that the American Health Care Act preserves many of the consumer protections for insurance coverage that are part of current law, such as guaranteed issue requirements and prohibitions against discrimination in underwriting based on gender, race, or health history. Yet we have strong concerns that other provisions of this legislation would still leave many Americans without adequate access to affordable care. For example, while the essential health benefits categories are being maintained for individual market plans, actuarial value requirements and cost-sharing subsidies are being repealed. Combined with a shift to basing tax credits for purchasing coverage largely on age rather than income, many Americans could be left in a position of being able to perhaps obtain coverage of more limited value, but not afford their actual care. Additionally, we are concerned by CBO’s projection that the 30 percent premium penalty that will be levied on those who do not maintain continuous coverage will further disincentivize younger and healthier Americans from seeking coverage – which could intensify the imbalance already present in the current individual insurance market.
We also remain deeply concerned about the drastic changes to the Medicaid program the American Health Care Act seeks to make. The AOA supports ensuring access to care for the most vulnerable in our nation of all ages, including those who lack the resources to directly access it themselves, and is concerned that the changes proposed for the Medicaid program will significantly impact coverage for these Americans. We do appreciate the additional funding the American Health Care Act provides for community health centers. The AOA has long supported efforts to increase access to primary care services in rural and underserved areas, and community health centers play an important role in providing such care.
We noted in our January letter that our health care system should have a foundation based on prevention and care coordination. We added that the AOA therefore strongly supports Congress and the Administration incentivizing delivery models like the patient-centered medical home that enhance and promote the foundational role of primary care physicians, and emphasize the provision of coordinated care across the health care spectrum. Yet the legislation does not address health care delivery models at all and, as noted, does not make any changes to continue to tackle the more fundamental issue of rising health care costs. Additionally, the legislation eliminates the Prevention and Public Health Fund, which supports key prevention, wellness, and public health initiatives. Prevention is a primary focus of the osteopathic philosophy, and we are unable to support such provisions that will detract from it.
In summary, we are deeply concerned that passage of the American Health Care Act will leave a majority of the Americans who have been able to gain coverage and access to care in recent years worse off instead of better, and therefore can’t support in its current form. As well, the legislation does not address other priority issues our health care system currently faces, such as restrictions on graduate medical education that have left areas of our country without an adequate physician workforce, and rising health care costs that show no signs of abating.
We therefore urge you to halt further progression of the American Health Care Act through the legislative process, and instead seek other ways to stabilize insurance markets while ensuring access to both coverage and care for all Americans. The AOA stands ready to assist you in developing such other approaches, and remains hopeful you will consider our perspective in the coming days.”