After many fits and starts, Republicans in the House of Representatives have finally succeeded in passing a bill that would, if the Senate concurs, repeal the Affordable Care Act, the landmark legislation that provides the current framework for the U.S. health care system.
Voting mostly along party lines — with 217 Republicans in favor and 193 Democrats and 20 members of the GOP opposed — representatives advanced a measure that would fundamentally alter a sector that affects every American and accounts for almost 20% of the nation’s economic activity.
Crafted by the House majority leadership with the support of the Trump administration, the American Health Care Act (AHCA) would unravel many of the ACA’s most important provisions.
The bill would, among other things, do away with the requirement that individuals obtain health coverage or face tax penalties; end subsidies for low-income people who buy insurance on government-run exchanges and replace them with tax credits; allow insurance companies to charge older Americans five times as much as younger adults, up from three times more under the current law; permit states to request a waiver from federal rules mandating minimum health benefits, including prescription medications; and provide funding for states to offer coverage for high-risk patients with preexisting conditions.
Far reaching as those provisions are, arguably the biggest changes are an $880 billion reduction in Medicaid spending over the next decade, a shift in the way funds are allotted to states under the program, and an end to the expansion of Medicaid triggered by the ACA.
Proponents of the AHCA characterize it as a necessary transformation of a system that is failing, one that President Trump, following House Republicans’ unsuccessful bid to roll back the ACA in March, said would explode if Congress did not act.
“We want to brag about the plan,” Trump said at a White House ceremony after the revised repeal measure passed earlier this month. “Yes, premiums will be coming down; yes, deductibles will be coming down, but very importantly it’s a great plan.”
Democrats and many health care and consumer groups reject that assertion. The American Medical Association, the American Nurses Association, the American Heart Association, the National Organization for Rare Disorders and AARP are just some of the groups that have voiced opposition to the bill.
Among myriad reasons for their opposition to AHCA, most of the organizations cite the Congressional Budget Office assessment of the original House bill (the version that passed earlier this month was voted on without the benefit of a new CBO score or public hearings) some 24 million individuals could lose health coverage over the next decade if the proposal was enacted.
Coming shortly after the conclusion of the NACDS Annual Meeting, the House vote highlighted the importance of the association’s drive to extend its vision and reach. In his last presentation as NACDS chairman, Martin Otto, chief financial officer and chief merchant at H-E-B, touched on themes that he has emphasized for the past year. “It has meant a lot to me personally to be able to discuss the need for a comprehensive, end-to-end review of the health care system, and to work with the NACDS board of directors and membership to position pharmacy as a major part of the solution to the many challenges facing the nation.”
Together with NACDS president and chief executive officer Steve Anderson, Otto spearheaded the creation of a Future Value Targeting initiative, which is focused, in Anderson’s words, on finding “additional common ground, with existing and new partners, to create immediate and long-term breakthroughs — for our businesses, for our partners and for the people we serve. That’s the concept of shared value, and it’s where business success aligns with societal gain.”
Alex Gourlay, NACDS’ new chairman and co-chief operating officer of Walgreens Alliance Boots, endorsed that course of action, placing particular emphasis on the patient and the customer.
“The whole association of NACDS is going to be based on that theme moving forward,” he said during his formal remarks at the conference, “in meeting the health care challenges that Martin Otto described and in advancing the Future Value Targeting initiative that Steve Anderson described. Through the Future Value Targeting initiative, we are looking to lead the industry in a proactive and positive way, at a time when we have so much to offer.”
With the very structure of the U.S. health care system now back in play, NACDS could not have chosen a better time to deepen its involvement in helping shape public policy.