Members of the Zetema Project, a diverse panel of healthcare leaders representing both parties and all the major stakeholder groups, are offering their responses to the replacement of the Affordable Care Act (ACA) recently proposed by House Republicans. The American Health Care Act (ACHA) seeks to fulfill President Trump’s campaign promise to immediately repeal and replace the ACA, and the President has enthusiastically endorsed the bill.

The responses of Zetema panelists to the AHCA are as diverse as the group itself. Several of the panelists used strong language to condemn the law:

  • American Medical Association chief executive James L. Madara wrote in an open letter: “We cannot support the AHCA as drafted because of the expected decline in health insurance coverage and the potential harm it would cause to vulnerable patient populations.”
  • Obamacare architect Ezekiel Emanuel wrote in the New York Times: “This would be even worse than going back to the days before the Affordable Care Act. It would force states to ration care and deny some Americans lifesaving treatments or nursing home care. Cruel only begins to describe the Republican plan.”
  • Bob Kocher, Obamacare advisor and partner at Venrock, writing on the Zetema Project blog, called the bill “a tragic step backwards.” He lamented that the bill “…cuts Medicaid dramatically” and reduces incentives for insurers to stay in the ACA’s exchanges while slashing research, preventive, and public health programs.
  • David Himmelstein, Professor at the CUNY School of Public Health at Hunter College and a leading advocate of single-payer healthcare, said: “The Republican proposal amounts to a rebranded and much meaner version of the ACA.  That's not surprising since the ACA was built according to the template originally proposed by Richard Nixon, later refined by the Heritage Foundation and Senate Republicans (in 1993) and first implemented by Mitt Romney in Massachusetts.  The House bill would evict millions from coverage, and grant huge tax breaks to the wealthy…the Republicans are proposing a big step backward.”
  • Debra Ness, President of the National Partnership for Women and Families, wrote in a statement: “Now that the bill has been revealed, it is clear why Republicans didn’t want people to see it. Their proposal radically overhauls and cuts Medicaid while simultaneously gutting the ACA by repealing financial assistance for low-income families and making it harder for people to afford coverage…[o]ur country’s women and families deserve better.”

Others expressed concern about the putative benefits of the AHCA:

  • American Nurses Association President Pamela Cipriano cautioned: “Replacement of Medicaid expansion with capped block grants and uncertain funding for subsidies should raise serious doubts about the credibility of the claims that this legislation will improve access or quality of care for the American people.” 
  • J. Mario Molina, chief executive of Molina Healthcare Inc., a managed care company that has expanded enrollment under the ACA, said "The American Healthcare Act fails to address the rising cost of health care and simply shifts the financial burden from federal to state governments. More importantly, it will result in millions of people losing coverage. By removing the individual mandate, this legislation will have a destabilizing effect on the Marketplace and increase premiums significantly. Additionally, replacing subsidies with less generous tax credits and eliminating CSRs will drive up the cost for consumers. The bill not only impacts the individual Marketplace, but will also result in dramatic cuts to the Medicaid program, which is the most effective way to provide health coverage for low-income Americans. Molina’s mission to provide quality health care to people in need remains our focus, and we will work closely with our partners in Congress and the administration to advocate for cost-effective solutions."

 But other Zetema panelists generally were positive about the AHCA and in particular saw the increased flexibility of the law, along with increased patient choice, as potential advantages of the bill over the Affordable Care Act. Some see the rules and regulations imposed by the ACA as having stifled innovation and meaningful changes in the care delivery system, and look forward to a repeal.

Some panelists were enthusiastic about the plan design freedom that would be restored under the AHCA, that “Qualified Health Plans” and “minimum essential coverage” would be eliminated. They believe that these regulations added cost and often incented unnecessary care by providers, so eliminating them should be a cost-saving measure.

  • Alex Azar, former President of Lilly USA, and former Deputy Secretary of the U.S. Department of Health and Human Services (2005-07), writing on the Zetema Project blog, called the bill a  “useful starting point for the debate that will now ensue on how to repeal and replace the mess that is Obamacare… We need to reduce the role of the national government in healthcare, fix the damage done to the individual market, restore choice to people, give flexibility to states, relieve Obamacare's burdensome taxes on individuals and businesses, and get HHS out of the business of being the nation's insurance commissioner.” 
  • Jack Bailey, President, US Pharmaceuticals at GlaxoSmithKline, says, “We are pleased to see that the draft bill maintains some of the most popular aspects of the ACA. We also hope Congress will recognize the importance of preserving continuity of care, particularly for vulnerable patients living with chronic conditions like HIV, and access to important preventive services, such as vaccines and cancer screenings.”
  • Stanford Hoover Institute Fellow Lanhee Chen, speaking on the PBS News Hour, lauded the replacement of the Individual Mandate with the Continuous Coverage approach and believes the plan will reduce costs by increasing choice. He points out that the Republican philosophy is to expand access by reducing cost, and believes that the bill is a strong initial step in this direction. 

Several panelists noted that the non-partisan Congressional Budget Office (CBO) has yet to score the bill, so the two most important elements have yet to be formally determined: the proposal’s impact on health spending and coverage. The CBO estimates are anticipated sometime in the next week. 

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Mark Zitter
Chairman, Zitter Health Insights, Chair, The Zetema Project
Mark Zitter founded The Zetema Project in 2016 to help inform and energize the dormant national healthcare conversation. He is Chairman and... Read Bio