The 2016 elections brought physicians an excellent opportunity to rebuild America's health care systems, TMA officials say.
"Everything is on the table — the Affordable Care Act (ACA), Medicare, and Medicaid," said David Henkes, MD, chair of the Texas Delegation to the American Medical Association. "Today, we are crafting plans to remake the system so it truly serves our physician members and our patients."
Fortuitously, the interim meeting of the AMA House of Delegates brought dozens of TMA leaders together just four days after the Nov. 8 elections. They laid out key strategic directions that TMA staff will use to devise a detailed plan.
"We need one document for all physicians, all specialties, to take to Congress and the administration and say, ‘This is what medicine believes in,' " Houston facial plastic surgeon Russ Kridel, MD, a member of the AMA Board of Trustees, said at an hour-long health care reform conversation among members of the Texas Delegation to the AMA, who are in Orlando, Fla., for the interim meeting of the AMA House of Delegates. "We need to act now, and we need to do those things that will put us at the table."
"The ACA was a first step, now we need to take another step," said former AMA and TMA President Jim Rohack, MD.
The Texas physicians said they are looking for an approach that simplifies the health care system for physicians and patients, reduces the huge regulatory burden on physicians, and reduces the cost of U.S. health care.
"This whole system is just too complicated for most people to handle," said Dallas psychiatrist Clifford Moy, MD.
Many of the ideas in President-Elect Donald Trump's "Great Again" health care platform and the health care agenda in House Speaker Paul Ryan's "Better Way" plan are consistent with TMA policy.
TMA actively opposed passage of the ACA in 2010 but has since adopted an approach to "Keep what's good, fix what's broken, and find what's missing." Speaker Ryan echoed that approach during a Nov. 13 television interview, when he said, "We can fix what is broken in health care without breaking what is working in health care."
Six years of near absolute gridlock in Washington, DC, prevented even the tiniest ACA reforms from passing. One significant achievement — from TMA's "find what's missing" category — was the repeal of Medicare's Sustainable Growth Rate formula via the Medicare Access and CHIP Reauthorization Act (MACRA), which passed in 2015.
"Texas Solution" Gets New Life
It's important to remember that what happens in Washington not only affects Medicare, commercial health insurance, and coverage for uninsured patients, but also plays a big role in how states implement the Medicaid program.
"We are entering into a new time," U.S. Rep. Michael Burgess, MD (R-Lewisville), said at a fundraising reception TMA hosted for him in Orlando. "I would love it if the governors came to Washington and said, ‘OK, guys, you deliver the mail and secure the border, we'll take care of our sick folks.' That would be a far, far more reasonable way to approach it."
Dr. Burgess likely will be a key player in the health care debate in the next Congress.
Both the Trump and Ryan plans call for Medicaid changes that mirror the "Texas Solution" for expanded coverage that TMA has promoted since 2013. The Texas Solution calls for a comprehensive plan that:
- Improves patient care;
- Draws down all available federal dollars to expand access to health care for poor Texans;
- Gives Texas the flexibility to change the plan as our needs and circumstances change;
- Clears away Medicaid's financial, administrative, and regulatory hurdles that are driving up costs and driving Texas physicians away from the program;
- Relieves local Texas taxpayers and Texans with insurance from the unfair and unnecessary burden of paying the entire cost of caring for their uninsured neighbors; and
- Pays physicians for Medicaid services at a rate at least equal to Medicare payments.
TMA staff are preparing a white paper on "Post-Election Strategies for Health System Reform" for discussion at the TMA Advocacy Retreat, Dec. 2–3 in Austin.
Action, Nov. 15, 2016