The AMA strongly opposes the Senate's health-reform proposal

David O. Barbe, MD, MHA , Former President

A lot of big numbers have been tossed around in the days since Senate leaders unveiled a “discussion draft” of legislation—dubbed the Better Care Reconciliation Act of 2017 (BCRA)—that would dramatically reshape how our country’s health system is financed.

23 million is one of those figures. That is how many more people the Congressional Budget Office (CBO) estimated would be uninsured by 2026 if the American Health Care Act were enacted, relative to current law. And today, the CBO weighed in with its projection that 22 million more people would be uninsured by 2026 under the BCRA, again relative to the law as it stands. When such a figure is in the tens of millions, it is a number too high for America’s physicians and their patients to bear.

37 million is another number that comes to mind. That is how many children are covered by Medicaid, according to the Georgetown University Center for Children and Families. Nearly half of children in small towns or rural areas are covered by Medicaid, notes a recent report from the Georgetown center.  I practice in one of these areas—Mountain Grove, Missouri, a town of 5,000 with a median household income half the national average.

Those are the big numbers. But my mind keeps wandering back to a smaller figure: Two. Recently, I met two healthy, beautiful babies—twins who were born after just 27 weeks’ gestation, weighing less than 2 pounds. They spent their first three months of life in a Cleveland NICU.

"If I didn't have Medicaid, they wouldn't be there,” the twins’ mother, Lajuan Black, told me and the crowd assembled for a Cleveland press event the AMA held with seven other organizations that advocate for hospitals, seniors, babies, and patients with cancer, diabetes or cardiovascular disease.

Access to care for some of the most vulnerable members of our society—including those who require treatment for opioid-use disorder—would be threatened by the Senate proposal’s arbitrary, unsustainable, and shortsighted formula for funding Medicaid. At the 2017 AMA Annual Meeting, the AMA House of Delegates sent a loud, unequivocal message opposing the kind of per-capita caps found in the BCRA.

That is just one of the reasons why the AMA opposes this Senate proposal. Ideas such as extending cost-sharing reduction payments to stabilize the individual insurance market should be the start of serious discussions on how to improve the current law so we can ensure that high-quality, affordable health insurance is within every American’s grasp.

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