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FEDERAL | ASPS Engages in Senate Health Care Reform Effort

Following narrow passage by the House of Representatives of the deeply-flawed American Health Care Act (AHCA), the U.S. Senate is in the throes of developing its own, separate legislation to repeal and replace parts of the Affordable Care Act (ACA). In order to ensure that the priorities of plastic surgery are considered in that process, ASPS wrote to Senate leaders, as well as the chairs and ranking members of the Senate Finance Committee and the Senate Health, Education, Labor and Pensions (HELP) Committee, to encourage the Senate to incorporate the ASPS Principles for Health Care Reform within the chamber's legislative proposal. Additionally, ASPS joined the Alliance of Specialty Medicine's comments to Senate Finance Committee leadership which detailed the Alliance's priorities for health care reform. The Alliance was one of a small number of organizations to have input solicited by the Senate Finance Committee. The Alliance priorities, which hew closely to the ASPS's, where also submitted to Senators Bill Cassidy (R-LA) and Susan Collins (R-ME), who have drafted a separate healthcare reform proposal.

Negotiations in the Senate are ongoing as the majority party determines which elements of the ACA should be repealed, which should be modified and which should remain in place. The GOP does not yet have the fifty-one votes to bring the bill forward for a vote. Its rumored that Republicans are considering additional funding for opioid abuse treatment. Moderate Republicans, like Susan Collins (R-ME), continue to express concerns over the party's approach to changing Medicaid, which has encouraged serious discussion over whether to vary Medicaid payment rates by state in order to address discrepancies between those states that have expanded their programs and those that have not. In contrast, the most conservative members of the GOP are worried that Senate proposals have not gone far enough to repeal Obamacare regulations. The party is also split over a provision that would eliminate all federal funding for Planned Parenthood. While the bill has not been released, latest reports indicate that the Senate bill is not as drastically different from the House passed AHCA as originally assumed.

The Congressional Budget Office (CBO) score of the AHCA, which was released last month, remains a top concern during Senate negotiations. According to the non-partisan budget agency, passage of the AHCA would lead to 23 million more uninsured Americans over the next decade. The CBO also estimated that the AHCA would reduce the deficit by $119 billion over the same period. Insurance premiums are predicted to increase initially, and then later decrease by 20 percent in 2018 and another five percent in 2019. The CBO also predicted that proposed changes to the Medicaid program would reduce coverage for 10 million people and would cut program funding by $834 billion over the next decade.

The CBO warned that enacting the bill as written could undermine the stability of insurance markets in one-sixth of the country. As a result, older and sicker Americans would see a drastic increase in the cost of their insurance coverage. While the score was well-received by Speaker of the House Paul Ryan (R-WI) because it confirmed that the bill would lower the deficit, some Republican Senators warned that the CBO's analysis highlighted that an ACA repeal bill needed to do more to protect those with pre-existing conditions. Meanwhile, the U.S. Department of Health and Human Services (HHS) Secretary Tom Price questioned the score's accuracy.Senate Majority Leader Mitch McConnell (R-KY), reiterated that the ACA status quo was unacceptable, regardless of the CBO report. Ultimately, achieving success on ACA repeal will be difficult, and ASPS will continue to engage in the process to ensure that the priorities of plastic surgeons are voiced.

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