Year-end Anxieties Over ACA Repeal Worry States, Divide Physicians


As the end of the year approaches, nerves are fraying over the potential impact on patients and state budgets that could result from the dismantling of ACA. States that went all in with state insurance exchanges and expanding Medicaid are in a particularly vulnerable position, with California at the top of the hit list.

Meanwhile dissent has broken out in the nation’s biggest house of medicine, the American Medical Association, over its nearly immediate endorsement of president-elect Trump’s pick for the of Health and Human Services.

California faces a $20 billion budget shortfall if the bill is repealed, equivalent to 18% of the state’s general fund spending, projected to be $113 billion in 2017, writes an attorney in an op-ed in the Los Angeles Times.

In response to federal subsidy offers, California expanded access to Medicaid for an additional 3 million people using eligibility thresholds of 138% versus 100% of the poverty level; it also subsidized an estimated 1.2 million people who gained insurance on Covered California.

The estimated size of block grant funding as proposed in House Speaker Paul Ryan’s plan is expected to be about $14.3 billion, or roughly 25% of the current federal support, leaving California the option of covering the shortfall or leaving 4 million people without health insurance.

An article in the Washington Post suggests that 6 million people nationwide could lose subsidies for the health insurance they’ve purchased on exchanges, which are expected to total $9 billion in 2017. Because insurers would be on the hook for the assistance, such an action by the administration to end the subsidies would likely prompt some insurers to bail and others to raise prices. An agreement payors sign with CMS on participating in the exchanges acknowledges that their participation is based on the expectation of premium tax credits and cost-sharing reductions.

The article notes that the subsidies could be eliminated immediately as a result of a lawsuit brought by House Republicans against the Obama administration two years ago.

Meanwhile, a full-scale revolt has broken out in the physician community over the AMA’s eager endorsement of President-elect Trump’s choice for secretary of the Department of Health and Human Services (HHS), Rep. Tom Price (R-Ga), an orthopedic surgeon-turned-legislator and active foe of Obamacare, just hours after the announcement was made, Stat reports.

Two weeks prior to the endorsement, the AMA’s House of Delegates had reaffirmed AMA’s support for coverage expansion under Obamacare, so the endorsement prompted a letter of protest signed by 700 AMA members calling the endorsement “divisive.”

Furthermore, a Perspective column published in the New England Journal of Medicine compares Price to the two other physicians who have served as secretary of HHS and suggest that Price’s record as a legislator “demonstrates less concern for the sick, the poor, and the health of the public and much greater concern for the economic well-being of their physician caregivers.”

Today, a front-page article in the Wall Street Journal details Price’s active trading in individual health care stocks while serving in Congress, suggesting that Trump’s pick to head HHS may meet some strong head winds during his confirmation hearings.