AMA head: Obamacare has a cold, not a terminal illness

The Affordable Care essentially needs a tuneup, not the overhaul Republican lawmakers are pushing, the chief of the American Medical Association told an audience of healthcare executives in Florida on March 3.

Instead of talking about outright repeal, "we have to nurse this thing along," said Dr. James Madara, executive vice president of the Chicago-based national doctors organization. "We have to find things in the ACA that are not working as well as they might, and correct those."

The Trump administration and Republicans in Congress are trying to figure out how to make good on their promise to repeal and replace the ACA, without arousing too much opposition from stakeholder groups and the public. In a first draft of the American Health Care Act, floated last night, Republicans included refundable, age-based tax credits to help people buy insurance and ended requirements that individuals have coverage. The proposal eliminates many taxes used to fund Obamacare and would wind down a Medicaid expansion over the next few years. Read the bill here.

Some Republicans have expressed surprise at how complicated health reform is and have been taken aback by a sudden outpouring of support for the law in recent days in district town hall meetings.The public at large, and doctors especially, do not want to revoke access to insurance that covered 22 million new people. "Pre-existing conditions being covered, that's in the bank now. That is a huge improvement for our country, as is being on your parents' health insurance until age 26."

Speaking at a conference of healthcare thinkers and executives at the University of Miami, Madara said the AMA doesn't want to argue about this or that bill but wants to hold to certain principles: “maintaining the reforms that have been very popular and very good.” First among those is not to let any of the 22 million who have newly attained coverage lose their insurance. “We know that those who lose coverage and access live sicker and die younger. Physicians don't like that. We are against living sicker and dying younger,” Madara said.

What doctors find most objectionable in the way health reform has proceeded is the exhausting amount of data entry they must do to satisfy the requirements of electronic health record software. The EHRs offered by commercial vendors are awkward to use, take valuable time away from interacting with patients and don't talk to each other, Madara told Crain's in an interview.

“The failure of electronic medical records to allow interoperability means patients who go to the emergency room at Northwestern Memorial—and they've been a lifelong patient at University of Chicago—are seen as a completely new patient because there is no record.” Even if a person's insurance network includes two or three academic hospitals, if they want to see a specialist with a particular expertise at one institution and not the other, the medical record-keeping becomes very complicated. “The data flow behind this transfer is not robust at all; in fact it is very primitive.”

The issue of making Medicaid into a block grant to states instead of an entitlement is also a concern to the AMA, Madara said. Illinois is a Medicaid expansion state. As of March 31, 2016, Illinois had 2.9 million people enrolled in Medicaid, of whom 681,000 signed up as part of the ACA's Medicaid expansion.

If Medicaid were turned into a block grant, the amount of federal money would likely be capped, Madara said. “It might not flex with the cost of living or introduction of new technologies. We think Medicaid has been incredibly important for our vulnerable populations” and full funding ought to be sustained.

"AMA head: Obamacare has a cold, not a terminal illness" was originally published in Crain's Chicago Business.