ASN Voices Strong Concerns about new Senate Healthcare Bill

By Zach Cahill and David White

Following the Trail of the Affordable Care Act Debate: Part 16

American Society of Nephrology (ASN) President Eleanor D. Lederer, MD, FASN, has issued a response to the release on Thursday, July 13, of a revised version of the Better Care Reconciliation Act (BCRA) that is intended to repeal and replace the Affordable Care Act (ACA).  Dr. Lederer states “Unfortunately, the revised bill fails to address significant shortcomings present in the original bill and will adversely impact the health of millions of Americans, including those with kidney diseases.”

Dr. Lederer continues by pointing out that there are 40 million Americans with kidney diseases and nearly 700,000 with complete kidney failure. She states that these individuals need high-quality care regardless of socioeconomic status and that this bill does not achieve that goal, concluding “the revised version of BCRA does not meet the needs of the American people, so ASN cannot support this bill.” 

The previous version of the Better Care Reconciliation Act was widely opposed across various sectors of the healthcare community and the new version is likely to be opposed just as vigorously – if not more so. 

The basic structure and shortcomings of the original legislation remain intact.  The bill continues to repeal individual and employer mandates, cut nearly $800 billion out of Medicaid and end Medicaid expansion, and eliminate cost-sharing subsidies as currently structured by 2020.  It does add $70 billion to the bill’s stabilization fund on top of the $112 billion already in the last version, and adds $45 billion to combat the Opioid crisis. These additional funds are provided by striking the repeal of various taxes proposed by the previous bill. 

However, there is one change to the new Better Care Reconciliation Act that is very troubling to ASN and peer societies.  The bill includes language similar to the amendment being pushed by Senators Ted Cruz (R-TX) and Mike Lee (R-UT), which allows insurance companies to sell stripped-down plans that do not meet the ACA’s Essential Health Benefits requirement as long as the company offers one ACA compliant plan. 

This would mean that if an insurer had at least one compliant plan, the insurer could offer other plans that factor in pre-existing conditions when charging customers, a main point of opposition for many critics of the repeal process. Insurers could effectively avoid offering other Essential Health Benefits in a similar fashion, such as ambulatory services, or treatment for mental health and substance use disorders.

ASN has adopted a set of Guiding Principles for Healthcare Reform.  Dr. Lederer maintains that when evaluating this bill, it “will not achieve the important goals outlined in ASN’s Guiding Principles for Health Reform.”  Furthermore, the bill “does not address the specific concerns ASN raised in its letter to Senate leadership in response to the release of the initial version of the bill, concerns that have been underscored by many members of the healthcare community.” ASN wrote to Senate leadership to voice its concerns on June 26. 

ASN’s Guiding Principles are:

1.    Provide access to affordable care for all Americans
2.    Protect the integrity of the patient-physician relationship
3.    Emphasize access to evidence-based screening, detection, and preventative care
4.    Guarantee access to care for Americans with pre-existing conditions
5.    Encourage development of innovative, cost-efficient, physician-driven care delivery models
6.    Ensure predictable, continuous access to immunosuppressant drugs for transplant recipients
7.    Support policies to facilitate kidney transplantation and organ donation

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Following the Trail of the Affordable Care Act Debate: Part 16

American Society of Nephrology (ASN) President Eleanor D. Lederer, MD, FASN, has issued a response to the release on Thursday, July 13, of a revised version of the Better Care Reconciliation Act (BCRA) that is intended to repeal and replace the Affordable Care Act (ACA).  Dr. Lederer states “Unfortunately, the revised bill fails to address significant shortcomings present in the original bill and will adversely impact the health of millions of Americans, including those with kidney diseases.”

Dr. Lederer continues by pointing out that there are 40 million Americans with kidney diseases and nearly 700,000 with complete kidney failure. She states that these individuals need high-quality care regardless of socioeconomic status and that this bill does not achieve that goal, concluding “the revised version of BCRA does not meet the needs of the American people, so ASN cannot support this bill.” 

The previous version of the Better Care Reconciliation Act was widely opposed across various sectors of the healthcare community and the new version is likely to be opposed just as vigorously – if not more so. 

The basic structure and shortcomings of the original legislation remain intact.  The bill continues to repeal individual and employer mandates, cut nearly $800 billion out of Medicaid and end Medicaid expansion, and eliminate cost-sharing subsidies as currently structured by 2020.  It does add $70 billion to the bill’s stabilization fund on top of the $112 billion already in the last version, and adds $45 billion to combat the Opioid crisis. These additional funds are provided by striking the repeal of various taxes proposed by the previous bill. 

However, there is one change to the new Better Care Reconciliation Act that is very troubling to ASN and peer societies.  The bill includes language similar to the amendment being pushed by Senators Ted Cruz (R-TX) and Mike Lee (R-UT), which allows insurance companies to sell stripped-down plans that do not meet the ACA’s Essential Health Benefits requirement as long as the company offers one ACA compliant plan. 

This would mean that if an insurer had at least one compliant plan, the insurer could offer other plans that factor in pre-existing conditions when charging customers, a main point of opposition for many critics of the repeal process. Insurers could effectively avoid offering other Essential Health Benefits in a similar fashion, such as ambulatory services, or treatment for mental health and substance use disorders.

ASN has adopted a set of Guiding Principles for Healthcare Reform.  Dr. Lederer maintains that when evaluating this bill, it “will not achieve the important goals outlined in ASN’s Guiding Principles for Health Reform.”  Furthermore, the bill “does not address the specific concerns ASN raised in its letter to Senate leadership in response to the release of the initial version of the bill, concerns that have been underscored by many members of the healthcare community.” ASN wrote to Senate leadership to voice its concerns on June 26. 

ASN’s Guiding Principles are:

1.    Provide access to affordable care for all Americans
2.    Protect the integrity of the patient-physician relationship
3.    Emphasize access to evidence-based screening, detection, and preventative care
4.    Guarantee access to care for Americans with pre-existing conditions
5.    Encourage development of innovative, cost-efficient, physician-driven care delivery models
6.    Ensure predictable, continuous access to immunosuppressant drugs for transplant recipients
7.    Support policies to facilitate kidney transplantation and organ donation

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