Repeal, replace, full of doubt

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The release of the American Health Care Act (AHCA) as a replacement to the Affordable Care Act (ACA) saw much condemnation and little praise.

March 31, 2017
Elizabeth Engler Modic Editor | emodic@gie.net

The release of the American Health Care Act (AHCA) as a replacement to the Affordable Care Act (ACA) saw much condemnation and little praise – and this was before the Congressional Budget Office (CBO) released its customary report. Almost as fast as experts began analyzing its potential impact, industry groups – American Medical Association (AMA), American Hospital Association (AHA), American Nurses Association (ANA), American College of Physicians (ACP), American Academy of Family Physicians (AAFP) – released statements enumerating their concerns.

Endorsement for the legislation: tepid. Supporting the bill was The Advanced Medical Technology Association (AdvaMed), in a statement that “commends the House Ways and Means Committee for moving forward with legislation that will permanently repeal the medical device excise tax…associated with a significant loss of American jobs…the medical technology industry experienced a decline of nearly 29,000 U.S. jobs while the tax was in effect.” The release adds that analysis from the American Action Forum demonstrates that a permanent medical device tax repeal “could result in excess of 53,000 additional industry jobs… Repealing the tax will provide medical technology innovators with the long-term certainty necessary to support future job growth and sustainable, cutting-edge R&D that will ultimately lead to the next generation of breakthroughs in patient care and treatment.”

Despite AdvaMed’s optimism, doubt remains. A March 16, 2017 article in the Washington Post notes that a January 2015 survey by Emergo Group found more than half of 685 executives in U.S. medical device companies didn’t make any significant business changes in 2014 in response to the tax. And, while Emergo has not conducted a recent version of that survey, its 2017 Industry Outlook survey showed that “medical device companies expect better sales performance in established markets in the U.S. and Europe more so for 2017 than in previous years.” You can download the report at https://goo.gl/uN6g3p.

Even House Speaker Paul Ryan (R.-Wis.) acknowledged the need for “fine-tuning improvements to the bill to reflect people’s concerns.” What I see as the biggest concern is that a review by the Congressional Budget Office (CBO) found that with the AHCA, 14 million people would lose coverage in 2018, expanding to 24 million without health insurance after 10 years, while leaving those covered with higher deductibles and copays, combined with less coverage.

No matter how healthcare is tweaked, repealed, or replaced, one key issue remains: the cost. National health expenditures topped $3.35 trillion in 2016, more than $10,000 person. For reference, in 1970 it was about $75 billion, a mere $356 per person. Add to that the U.S. spending 2.5x the Organization for Economic Co-operation and Development (OECD) average among 33 developed countries and you why there’s concern for the whole system.

While I don’t have a fix-all answer for healthcare in this country, one thing is certain – costs continue to grow and no one wants to pay. I want to know how you think healthcare in the U.S. can be fixed, because President Donald Trump said in a 60 Minutes interview, “Everybody’s going to be taken care of much better they’re taken care of now… the government’s gonna pay for it.” ~ Elizabeth