The Zetema Project is a diverse group of US healthcare leaders from across the political spectrum and major stakeholder segments that debates critical healthcare issues. Shortly after the American Health Care Act passed the US House of Representatives and prior to publication of the Congressional Budget Office scoring, we asked Zetema members to weigh in on the bill.
Of the 18 members who responded, 5 were in favor of the bill’s passing, while 13 were against. With the widely acknowledged understanding that, as one Zetema member put it, “[the bill] will not get through the Senate in its present form,” here is what they had to say:
Zetema members who opposed the bill called it “terrible policy,” “a political Frankenstein monster,” and “a very flawed piece of legislation that, if it were to be eventually enacted, will cause harm.” Another member commented about the process of passing the bill that “the House legislative process seemed to be more about fulfilling a campaign promise than actually improving the bill.” The member went on: “The process seemed rushed and many members didn't seem to understand what they voted for. And CBO hasn't even scored the bill yet! A better approach would have been to develop legislation targeted at what is actually wrong with ACA or not working, and then reach across the aisle and craft a solution together.”
Pam Cipriano, President of the American Nurses Association, said the bill “strips away health care from many who could not afford coverage before the ACA and Medicaid expansion, punishes those with pre-existing conditions, rewards the wealthy once again, and makes it [acceptable] for insurers and employers to deny women essential benefits and all others preventive care.” Echoing this strongly worded assessment was Debra Ness, President of the National Partnership for Women and Families. She commented, “Millions of people would lose coverage…People with pre-existing conditions or in need of certain services like maternity care or mental health care would find coverage unaffordable…Billions of Medicaid dollars would be shifted into tax breaks for the well-heeled. Planned Parenthood would be defunded and millions would lose access to preventive care and family planning services. Plans would once again resort to cherry picking and charging higher prices for inadequate coverage. Medical bankruptcies would increase. The skewed risk pool would make it harder and harder to insure sicker or older people. The ultimate burden on Medicare would increase.” Ness also noted that if the bill were enacted states would lose millions in Medicaid dollars over time, causing cuts in eligibility and services.
Interestingly, Gail Wilensky, a well-known conservative economist, criticized the bill because it “doesn't help the poor/low income population enough.” Former Obama healthcare advisor Bob Kocher simply stated that it “makes healthcare more expensive to those who need care.”
Meanwhile, those in favor balanced the argument by focusing on the putative systemic benefits of the bill. Zetema members in favor of the AHCA commented that it “begins [a] shift back to market-oriented administration of healthcare,” “eliminates some of the useless pieces of the ACA” and “gives…more freedom to employers.” Another Zetema member in favor called the bill a “first step in process toward some, even partial reforming of the unsustainable and unaffordable Medicaid expansion and individual subsidies.”