Cleaveland: First, do no harm in rush to new health plan

Cleaveland: First, do no harm in rush to new health plan

March 21st, 2017 by Dr. Clif Cleaveland in Life Entertainment

House Speaker Paul Ryan of Wis., center, standing with Energy and Commerce Committee Chairman Greg Walden, R-Ore., right, and House Majority Whip Kevin McCarthy, R-Calif., left, speaks during a news conference on the American Health Care Act on Capitol Hill in Washington, Tuesday, March 7, 2017. (AP Photo/Susan Walsh)

Photo by Susan Walsh

Hasty actions by Republicans in the U.S. House of Representatives are casting a pall of uncertainty over health care for many millions of Americans.

With little debate and no information about costs, House Speaker Paul Ryan is rushing the American Health Care Act (AHCA) toward early passage. Strong opposition, voiced immediately by health-care providers that include the American Medical Association, the American Osteopathic Association, professional organizations representing family physicians, pediatricians, obstetrician-gynecologists, internists and the American Hospital Association, has been ignored. Opposition from many individuals and patient-advocacy groups has fallen on deaf ears.

Dr. Clif Cleveland

Dr. Clif Cleveland

Photo by Contributed Photo /Times Free Press.

Speaker Ryan and his House allies have two goals: immediate repeal of many provisions of the Affordable Care Act of 2010 (ACA) and rapid replacement with a plan of unexamined impact upon the health care of Americans.

Kaiser Family Foundation ( offers a useful, succinct comparison of ACA and AHCA.

House Ways and Means and Energy and Commerce committees approved AHCA within days of its proposal without hearings or data regarding costs from the nonpartisan Congressional Budget Office, which traditionally analyzes the financial impact of legislation before debate begins.

A vote by the full House is planned for the near future.

Why the rush? Would you abruptly agree to purchase an uninspected house of uncertain cost?

Health care represents one-sixth of the nation's economy. Our system of health care represents a delicate, complex balance of public and private insurance programs. Removal of a critical piece can jeopardize the entire structure upon which the public's health depends.

Among the proposals in the AHCA that I find troubling:

' The repeal of funding for the Prevention and Public Health Fund at the end of fiscal year 2017. PPHF conducts research into improving health outcomes, preventing disease through screening and immunizations, and improving the workforce in public health.

* The elimination of individual and employer health mandates. This will reduce the pool of healthier persons who pay into health insurance pools, which will lead to higher health insurance premiums.

* Replacing income-based tax credits, to assist in the purchase of health insurance, with age-based credits. These range from $2,000 to $4,000 per year. This does not factor in wide, regional variations in health care costs and sharp rises in health care costs as we age.

* Allowing private health insurance premiums to rise five-fold for older Americans, in contrast to the present three-fold limit.

* The gradual shift of Medicaid to a per capita cap. This could limit costly treatment for diseases such as cancer. Allow states to design and implement their own programs.

* The phase-out of higher federal matching funds for states that chose to expand their Medicaid programs. This expansion was a major factor in reducing the numbers of uninsured.

* Imposing a penalty of a 12-month, 30 percent increase in premiums for individuals who lose continuous health insurance coverage for 63 or more days.

* Increasing annual tax-free contributions to health savings accounts, which favors wealthier Americans.

* Ending federal funding for Planned Parenthood clinics, denying contraceptive services to many poor women.

In the short interval following release of the AHCA, independent analysts argue that premium costs for older and poorer Americans will rise sharply. Health insurance will become unaffordable for many people. States that have consistently poor records in Medicaid administration are unlikely to use Medicaid block grants wisely. The public will have inadequate information for making wise choices among new health insurance products, which may, for instance, impose lifetime limits on coverage.

Though not perfect, the ACA expanded coverage to 22 million Americans who were previously uninsured. Mental health and addiction services along with an array of preventive measures were covered without co-payment or deductible. Health insurance practices were standardized.

Our health system is not "broken," as some politicians contend. Rather it is a system in need of continual, thoughtful, compassionate refinement. In particular, we must solve the complex problem of runaway costs, especially in pharmaceuticals and clinical procedures.

On March 13, the CBO released its study of the AHCA, estimating that it would reduce the federal deficit by $337 billion and increase the number of uninsured Americans by 26 million over the next 10 years.

A guiding, ethical principal in health care is "first, do no harm." The same principle should apply to policymakers. Speaker Ryan owes the public a careful and thorough analysis of the AHCA with ample time for analysis and commentary by critics and supporters alike.

Slow down! Lives are at stake.

Email Clif Cleaveland at

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