Hope for the American Health Care System

by Phil Roe, M.D.,  U. S. Representative 1st District of Tennessee, May 12, 2017- Last Thursday, Republicans in the House of Representatives took a giant step toward fulfilling our promise and President Trump’s pledge made to the American people that we would repeal Obamacare and replace it with patient-centered, free-market health care. The House-passed bill, H.R. 1628, the American Health Care Act (AHCA), will take away power from Washington bureaucrats and return it to the American people.

I’ve been opposed to Obamacare from the start, in large part because as a doctor, I’ve seen first-hand what happens when you take power out of the hands of patients and their doctors and centralizes it in the hands of government bureaucrats. In Tennessee, we had our own experiment with universal access to care under TennCare. What happened? Costs exploded, forcing the state to remove people from the rolls, which resulted in one of the most stringent systems in America.

Across the country, Obamacare is failing, especially in East Tennessee. While it was welcome news that on May 9 Blue Cross Blue Shield of Tennessee announced it would offer a plan option for residents of the Knoxville marketplace, one plan option is not real choice. In 2016, premiums across Tennessee increased an average of 46 percent, with many individuals seeing their premium increase more than 60 percent. These increases were on top of the explosion of deductibles and out-of-pocket costs, which make it extremely difficult for the middle class to afford necessary medical care. You can see that with how hospital systems in our area are now are seeing 60 to 70 percent of their uncollectible debt coming from people with insurance. That’s why we are acting.

One thing I’ve heard consistently since this debate started is how much people are concerned about losing their health insurance due to a pre-existing condition. There’s no doubt about it: the last thing you want to be doing when your loved one is sick or dying is worrying about whether you are covered. As a doctor, I can’t tell you how frustrating it is to have to jump through all the bureaucratic hurdles to get life-saving care approved. I want to protect people with pre-existing conditions – but we believe there is a better way to achieve these protections without driving up the cost of health insurance and making coverage unaffordable for millions of Americans.

That’s why I’m proud to say, despite a great deal of misinformation being circulated, the AHCA continues strong protections for people with pre-existing conditions. The AHCA requires insurers to cover individuals regardless of their health status, while also prohibiting insurers from charging higher premiums because of one’s illness. Individuals who maintain health insurance will be protected by a “community rating” that prohibits charging higher premiums, and individuals who don’t maintain continuous coverage will have to pay a 30 percent surcharge – instead of taxing you on the front end if you fail to purchase government-approved coverage.

We also added an amendment to give states the flexibility to experiment with better plan designs that can lower premiums, stabilize the insurance market or improve conditions for people with pre-existing conditions. If you look at the experiences of states like Maine and Wisconsin, we know it is possible to lower costs for everyone – including people with pre-existing conditions – when states are given the opportunity to opt out of Obamacare’s strict regulatory structure.

Aside from the continued protections for pre-existing conditions, the AHCA should be a welcome improvement over Obamacare’s status quo. We create a refundable tax credit which helps bring parity to individuals who purchase health insurance on their own with individuals who receive health insurance through their employer. We expand health savings accounts, which incentivize high-deductible health plans. Because studies have shown Medicaid doesn’t improve health outcomes over being uninsured, we give states the ability to restructure their Medicaid programs, improving access to care for millions of beneficiaries.

Now, it is the Senate’s turn to act. I have said it before and I’ll say it again: AHCA is a great start, but it’s not a perfect bill, and I hope our Senate colleagues will try to build on the work the House has done. One thing is certain – we cannot afford not to act. I look forward to helping East Tennesseans obtain the affordable health care coverage they deserve.

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