TMA Offers Health System Reform List to House Leaders

In response to outreach from U.S. House Majority Leader Kevin McCarthy (R-Calif.), House Ways and Means Committee Chair Kevin Brady (R-The Woodlands), and other House Republican leaders, TMA provided a list of nine health care policy suggestions for the next Congress to consider. 

The House leaders asked the nation's governors and state insurance commissioners to submit suggestions for replacing the Accountable Care Act and improving Medicaid. Our list includes ACA, Medicare, and Medicaid reforms that are consistent both with TMA policy and with the proposals already laid out by President-Elect Donald Trump and House Speaker Paul Ryan. 

"Most of the flaws of the ACA — its errors both of commission and omission — remain," TMA President Don Read, MD, wrote. "We believe that the 2016 elections bring an excellent opportunity to rebuild America's health care systems in ways that can be extraordinarily meaningful for our patients and the physicians who care for them." The suggestions in Dr. Read’s letter are:  

  • Replace ACA subsidies.

In their place, Congress should establish universal, advanceable, refundable tax credits (age and cost-of-living adjusted) for individuals and families who do not have access to employer-sponsored coverage. These credits should be available through multiple portals, not just the health insurance exchange. Any credits in excess of the insurance premium can be deposited into health savings accounts. 

  • Repeal the employer mandate.
  • Keep ACA protection of insurance for people with preexisting conditions, as long as they have continuous coverage.  

While Congress was debating ACA, TMA conducted 16 town hall-style meetings on health reform across Texas with more than 3,000 patients and physicians participating. At every meeting, both patients and physicians called on Texas legislators and Congress to prohibit health insurance companies from excluding coverage for patients with preexisting conditions. Patients need access to health care coverage, especially when they suffer from an ongoing medical condition.

Enact the Texas Medicaid Solution to increase coverage for low-income adults and require some of the administrative cost savings to be used to fund fee increases for physicians. 

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. 
  • Give physicians the ability to contract directly for any and all Medicare services.  

As increasing numbers of baby boomers reach Medicare age, flexibility in Medicare is necessary to ensure patients have access to a physician. One way to accomplish this is to allow Medicare patients to see any physician of their choice. Physicians should be allowed to enter into direct contracts with Medicare patients, without forcing patients to forego their Medicare benefits even when they opt out of the Medicare program. 

  • Repeal the ban on physician hospital ownership.  

Throughout the health care debate, the Mayo Clinic, Cleveland Clinics, and Texas' Scott & White Hospitals were held up as the gold standard for how to deliver efficient and high-quality care. All these institutions have one thing in common — they are physician-owned and physician-led. Now, these types of institutions are banned. A provision in ACA actually prevents physicians from establishing hospitals that participate in Medicare. ACA makes future hospital ownership illegal for physicians who go to medical school, obtain a license to practice medicine, care for Medicare patients, and then want to refer their Medicare patients to a hospital in which they may have ownership. If a physician had already owned a hospital, ACA severely limits how that hospital can expand and operate.

This provision of ACA limits patient choice; inhibits patients' access to high-quality, low-cost medical care; and prohibits physicians from making the clinical and business decisions we believe are best for our patients. 

  • Enact Texas-style medical liability reforms for the entire country.   

Texas has gained nearly 60,000 new physicians to take care of Texas patients since passage of our landmark medical tort reforms in 2003. Many of these new physicians practice high-risk specialties such as emergency medicine, neurosurgery, pediatric intensive care, and pediatric infectious disease. Texas patients now can get more timely and convenient care when needed. Some 28 rural Texas counties have added at least one obstetrician since the passage of Texas' medical liability reforms, including 11 counties that previously had none. The emergency care provisions have saved lives by helping ensure Texas patients have access to critical and timely care. The 2003 liability reforms have worked. They've lived up to their promise. Sick and injured Texans now have more physicians who are more willing and able to give them the medical care they need.

The rest of the nation will benefit from Texas-style reforms. We must ensure, however, that any federal law does not modify or change reforms now in Texas law. 

  • Expand use of health savings accounts and allow (untaxed) employer health reimbursement account contributions to be used for individual insurance purchase.  

We support innovative experiments in health care financing that attempt to control costs, maintain quality, and broaden access to care through implementation of market-based principles. We also believe Medicare beneficiaries should be permitted to make tax-free contributions to health savings accounts. 

  • Repeal the Independent Payment Advisory Board (IPAB).  

The 15-member IPAB has the authority to control Medicare spending. IPAB can make recommendations that lead to decreases in Medicare spending only through lower payment rates to physicians. IPAB recommendations would become law automatically unless Congress passes a law to reach the same budgetary savings. The issue of Medicare spending is too important to be left in the hands of an unaccountable board with decisions based solely on cost.

"Physicians and our patients are demanding significant change," Dr. Read wrote. "We look forward to working closely with you, the White House, the Texas members of the U.S. Congress, Texas Gov. Greg Abbott and his administration, and the Texas Legislature in the coming months and years to accomplish these ambitious goals."

The TMA Board of Trustees, Council on Socioeconomics, and other entities will continue to work to identify priorities for Congress to consider.

Action, Dec. 15, 2016