News: Responses to ACA repeal—AHCA proposal raised serious concerns from healthcare industry associations

Healthcare in America is in flux. Although tabled on Friday, March 24, the proposed American Health Care Act (AHCA) – the attempted replacement for the Affordable Care Act (ACA) –nevertheless raises many healthcare policy questions and uncertainty regarding the status of previous pay-for-performance and value-based purchasing initiatives.

As government officials rolled out plans for the AHCA, many healthcare organizations expressed concern over the proposed bill; reviewing these releases and letters help to highlight potential pitfalls of the legislation and point out and trouble spots CDI specialists should be aware of.

The American Hospital Association (AHA) wrote a letter to Congress immediately after the release of the AHCA, prior to the cost estimate released by the Congressional Budget Office on March 9.

In their letter, the AHA outlined several concerns regarding the proposed legislation. Two of their largest concerns are as follows:

• The restructure of the Medicaid program will make reductions in the program that already pays providers significantly less than the cost of the care provided
• The repeal removes much of the funding dedicated to provide coverage in the future

Their letter urged Congress that the decision process should be “thoughtful and focused on finding ways to improve our health care system, particularly for the poor, elderly, and disabled.”

“We cannot support the American Health Care Act in its current form,” the AHA closed.

The AHA was not the only organization to respond. The American Medical Association (AMA) sent its own letter in response to the original AHCA release.

Though the AMA also dissented to the proposed legislation, they outlined some different concerns than the AHA, including:

• The proposed tax credit system would be based on the individual’s age rather than income. This model would result in fewer people who could afford coverage even with the credit.
• The restructuring of the Medicare program could put the coverage for mental health and substance abuse treatment in serious jeopardy.
• The repeal of the Prevention and Public Health Fund would limit patients’ ability to receive care from providers of their choice.

Much like the AHA’s letter, the AMA closed their letter by urging law makers to “Keep utmost in your mind the potentially life altering impact your decisions will have on millions of Americans.”

Additionally, the AHCA pose some especially unique concerns for pediatric programs.

In the current form, the legislation raises questions about how the more than 30 million children in the Medicaid program will be protected under its provisions, according to the Children’s Hospital Association. As drafted, the bill would have:

• Converted the Medicaid program’s financing structure to a per capita cap model which would limit future federal funding to states, risking significant reductions in the Medicaid budgets providing the care for children.
• Modify program eligibility standards that could impact children’s benefits in Medicaid (though the specifics were unclear)

Though many provisions for pediatrics remain untouched by the proposed bill, CDI specialists in pediatric settings may see a change in the payment methodology should the bill pass into law. To read the Children’s Hospital Association’s coverage of the AHCA’s implications for pediatrics, click here.