House Passes AHCA Bill Amid Protests From APA, Other Groups

The U.S. House of Representatives voted 217-213 to pass the American Health Care Act (AHCA) last month after the bill had been amended to garner enough votes.

Immediately after the vote was announced, APA released a statement with five other major medical organizations to urge the Senate to “put aside” the AHCA and instead work with them to “achieve real bipartisan solutions to improve affordability, access, and coverage for all.”

The five groups that signed onto the statement with APA were the American Academy of Family Physicians, American Academy of Pediatrics, American College of Physicians, American Congress of Obstetricians and Gynecologists, and American Osteopathic Association. They represent more than 560,000 physicians and medical students. APA was part of the same coalition of organizations that had expressed its strong opposition to the AHCA in late April.

The AHCA, a proposed replacement of the Affordable Care Act, initially was scheduled for a House vote on March 24, but House Speaker Paul Ryan (R-Wis.) opted to postpone the vote because at that time there were not enough votes to pass the bill.

There were concerns at the time that millions of people would be unable to afford health insurance because of lower federal subsidies as well as higher premiums, copayments, and deductibles. Other issues were whether people with pre-existing conditions would lose coverage, and the proposal to allow states to drop the mandate to cover 10 “essential health benefits,” of which mental health care is one. Instead, states would have been permitted to define which benefits must be a part of that state’s marketplace.

Under the version of the bill that passed the House, $8 billion over five years has been added to the bill to help cover insurance costs for those with pre-existing conditions. The provision, which enabled the bill to garner enough votes in the House, is expected to face opposition in the Senate, however, because some members say it will not guarantee health care to those with pre-existing conditions.

“There are two schools of thought” on what will happen in the Senate, said Ariel Gonzalez, J.D., APA’s chief of government affairs. One is that the Senate version of the health care bill will move quickly—within 90 days. The other is that the Senate bill will take much longer to draft and will be “extremely different” from the House bill. When the House and Senate go to conference to reconcile the bill, it could die, Gonzalez said.

“Before and throughout the AHCA debate, our organizations continually offered constructive ideas on achieving agreement on legislation consistent with our shared principles,” APA and the five other organizations wrote in their statement. “Regrettably, the AHCA, as amended and passed by the House, violates our principles, dramatically increasing costs for older individuals, resulting in millions of people losing their health care coverage, and returning to a system that allows insurers to discriminate against people with pre-existing conditions.”

The six groups also oppose the AHCA’s Medicaid cuts, including “capping and cutting the federal government’s contribution to Medicaid, sunsetting federal funding for Medicaid expansion, and eliminating Medicaid coverage of essential benefits.

In addition to encouraging the Senate to not take up the AHCA “in any form,” the statement urges the Senate to take the following actions:

• Work to achieve real bipartisan solutions to ensure that coverage remains affordable.

• Stabilize the individual market. 

• Ensure long-term, adequate funding for the Children’s Health Insurance Program. 

• Make primary, preventive, and mental health and substance use services more readily available to all Americans. 

• Lower the costs of pharmaceutical treatments.

• Reform medical liability laws.

• Reduce the administrative and regulatory burdens that add costs and take time away from patients.

The statement concluded, “We stand ready to assist the Congress on achieving these and other necessary improvements.” ■