Understanding the American Health Care Act of 2017

Over the past year, we’ve been following developments regarding attempts to repeal and replace the Affordable Care Act of 2010. On the day President Trump was inaugurated, we published “Making Sense of Health Insurance in the Trump Era,” in which we highlighted some of the successes of the Affordable Care Act (ACA), and explained Trump’s initial plans for repealing and replacing the ACA with a plan that provides for “great healthcare for much less money.”

Two months later, we posted “8 Ideas on Healthcare Legislation from a Functional Medicine Perspective,” in which we presented possible initiatives for reducing healthcare costs while improving results. Since then, the American Healthcare Act of 2017 (AHA) narrowly won passage in the House of Representatives, but that was only the first hurdle. It must also win passage in the Senate, which will probably be the bigger hurdle. The Senate will probably demand changes, and even with changes, the bill may not receive enough votes.

What do we think of the AHA at this point? Not much. President Trump made two promises — “great healthcare” and “for much less money.” Let’s take a look at those two promises.

Great Healthcare

Whenever anyone in government talks about quality healthcare, they’re usually referring to conventional medical tests and treatments. For most of them, great healthcare means free access to doctors, tests, and treatments. As functional medicine practitioners, our focus is on optimizing health, not merely eliminating illness or masking its symptoms. We envision a community, nation, and a world, in which people are healthy — free of chronic illness, such as allergies, asthma, diabetes, obesity, fatigue, colitis, and so on — and better equipped to fight infection and other illnesses. Instead of treating illness from the outside in (eliminating illnesses in the hope that it makes a person healthy), we treat illness from the inside out (restoring health and thus eliminating illness and preventing future illness). Our eight ideas on healthcare legislation are aimed at making people healthier.

Ours is not a passive-patient approach in which we merely write a prescription or order a treatment. To be healthy, patients must live healthy — consume healthy foods and beverages, be physically active, avoid environmental toxins, get restful sleep and enough of it, maintain positive relationships, and so on.

To us, great healthcare means making a sick patient healthy and keeping them healthy. Great healthcare is results oriented. And from what we’ve observed — a nation that’s getting sicker instead of healthier — we can’t exactly boast about the great healthcare we have in the U.S. Because of this, we have little hope that anything coming out of Washington D.C. or state governments will fulfill the promise of delivering “great healthcare,” and the current legislation contains nothing to make us change our view.

The American Healthcare Act of 2017 contains nothing to reward doctors for making people healthy and little to reward people for making positive lifestyle choices. The only reward is for providing treatments, and the sicker the nation gets, the more treatment will be required.

Worse than nothing, the current version of the bill amends the Patient Protection and Affordable Care Act (PPACA) to eliminate funding for the Prevention and Public Health Fund and increase funding for community health centers; in other words, less money for prevention and more money for treatment. However, this probably isn’t a great loss, given the fact that initiatives sponsored by the government and by conventional medicine, such as food pyramids and low-fat foods, have probably caused more illness than they’ve prevented.

For Much Less Money

The age-old wisdom of “an ounce of prevention is worth a pound of cure” remains unheeded by our government, especially under the current proposal to eliminate funding for the Prevention and Public Health Fund. Given the system’s unbreakable focus on eliminating illness instead of restoring health, it seems the government will continue to throw money in the wrong direction. The fact is that health is far cheaper than illness, and until we have legislation that promotes and funds the restoration and preservation of health, medical costs will continue to rise.

In addition, “for much less money” begs the question of “for whom?” For the poor? For the rich? For the government? For doctors? For insurance companies? For the insured or uninsured? To answer that question, you need to comb through the American Healthcare Act of 2017 for details or at least read a summary of the changes. You can find two summaries on Congress.gov — a summary reported to House without amendment and a (much shorter) summary introduced in the House.

Here are a few key changes proposed in the House bill that are likely to impact healthcare costs for various stakeholders:

• Allow states to waive rules for minimum benefits coverage and rules that prohibit insurance companies from charging higher premiums to people with pre-existing conditions. Any state that waives the rules will receive some federal funding to set up a program for high-risk individuals.
• Eliminate funding for the Prevention and Public Health Fund, which provides for investment in prevention and public health programs to improve health and restrain the rate of growth in health care costs.
• Amend the Medicare Access and CHIP Reauthorization Act of 2015 to increase funding for community health centers.
• Cut federal funding to states for certain family planning providers, including Planned Parenthood, for one year.
• Enable insurance companies to lower the cost of premiums for young customers and raise them for older customers.
• Eliminate the 0.9 percent increase in Medicare payroll tax and the 3.8 percent tax on investment income for individuals earning more than $200,000 and couples earning more than $250,000.
• Increase the amount individuals with high-deductible plans are allowed to contribute to their health savings accounts (HSAs).
• Eliminate the individual mandate to purchase health insurance.
• Replace subsidies to pay health insurance premiums with tax credits for eligible individuals who purchase health insurance.
• Require that insurance companies charge a 30 percent higher premium for one year to enrollees who haven’t maintained continuous coverage over the previous year.
• Allow people to purchase plans with lower premiums and higher deductibles, meaning they’ll save money on insurance but pay more out of pocket if they need medical services.
• Eliminate the employer mandate for large employers to provide health insurance for their employees.
• Reduce federal funding for some Medicaid programs.

These changes and others in the House bill, if it were to pass the Senate without changes, are likely to trigger other changes that will impact healthcare costs in some way. For example, according to the Congressional Budget Office, 24 million fewer people will have health insurance under this plan, meaning fewer people will be paying into the health insurance pools, applying upward pressure to the cost of insurance premiums.

In addition, hospitals and other healthcare providers will be treating more people without insurance, so they’ll need to charge extra to make up the difference.

If separate legislation is passed to allow health insurance companies to sell across state lines, there may be some downward pressure on the cost of insurance premiums, but nobody can say for certain that such legislation will lead to lower insurance premiums.

For a great analysis of who stands to gain and who stands to lose from the House AHA bill, check out The New York Times article by Margot Sanger-Katz, “Who Wins and Who Loses in the Latest G.O.P. Health Care Bill.”

How Would the House AHA Bill Impact Restoration Healthcare Patients?

If the House version of the American Healthcare Act of 2017 bill were to pass unchanged, which isn’t likely, we can say with complete certainty that everyone, including our patients, will be paying more or less or about the same for healthcare (in the form of health insurance premiums and out-of-pocket costs). However, the impact will vary based on numerous factors, including a person’s individual or family income, whether the person has any pre-existing conditions that require treatment, how healthy the person is, and what the person’s policy covers.

We help reduce your healthcare costs in two important ways:

• We team up with you to help you achieve optimal health. Nothing slashes healthcare costs more than being healthy.
• We have a savvy billing staff that keeps up to date on all insurance issues to give our patients the best medical care while reducing out-of-pocket costs. We have the answers — and solutions — for your health insurance questions and needs.

Whatever the future holds for healthcare, we have your back. Just let us know what your situation is and whether you have health insurance (and through whom), and we will work with you to explore solutions that meet your needs within your budget. One of our primary objectives is to remove any obstacles, financial or otherwise, that stand between you and the healthy life you envision.