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Metro Areas Increasingly Dominated by Single Insurance Companies

Posted by admin on October 27, 2017

In an analysis of competition in health insurance markets across the U.S., a study conducted by the American Medical Association found that in 169 of 389 metropolitan areas (43 percent), a single health insurer had at least a 50 percent share of the market. This represents an eight percent increase in such markets over just two years. The finding comes from the newly released 2017 edition of the AMA’s Competition in Health Insurance: A Comprehensive Study of U.S. Markets, which examines market concentration in 2016.

High market concentration tends to lower competition among commercial health insurers. These markets become ripe for the exercise of health insurer market power, which harms patients by raising premiums above competitive levels.

The AMA study presents the most comprehensive data on the degree of competition in health insurance markets across the country, and is intended to help researchers, policymakers and regulators identify markets where consolidation among health insurers may cause anti-competitive harm to patients and the physicians who care for them.

“After years of largely unchallenged consolidation in the health insurance industry, a few recent attempts to consolidate have received closer scrutiny than in the past, including the proposed mergers of Anthem and Cigna, as well as Aetna and Humana,” said AMA President David O. Barbe, M.D. “Previous versions of the AMA study played a key role in efforts to block the proposed mega-mergers by helping federal and state antitrust regulators identify markets where those mergers would cause anti-competitive harm.”

The 2017 edition of AMA’s Competition in Health Insurance: A Comprehensive Study of U.S. Markets offers the largest and most complete picture of competition in health insurance markets for 389 metropolitan areas, as well as all 50 states and the District of Columbia. The study is based on 2016 data on commercial enrollment in fully and self-insured health maintenance organization (HMO), preferred provider organization (PPO), point-of-service (POS), public health exchange and consumer-driven health plans (CDHP).

In addition to assessing competition in the commercial health insurance market at large, the study also separately examines competition for the main plan types, including HMO, PPO, POS, and the exchanges.

The prospect of future consolidation in the health insurance industry should be viewed in the context of the lack of competition that already exists in most health insurance markets. According to the AMA’s latest study:

A significant absence of health insurer competition was found in 69 percent of metropolitan areas. These markets are rated “highly concentrated” based on federal guidelines used to assess the degree of competition in a market.
In 43 percent (169) of metropolitan areas, a single health insurer had at least a 50 percent share of the commercial health insurance market, compared to 40 percent (156) in 2014.
Anthem has a bigger geographic footprint than any other health insurance company in the United States. Anthem was the largest health insurer by market share in 82 of 389 metropolitan areas examined by the AMA. Health Care Service Corp. was second with a market share lead in 42 metropolitan areas, followed by UnitedHealth Group with a market share lead in 26 metropolitan areas.
The 10 states with the least competitive commercial health insurance markets were: 1. Alabama, 2. Delaware, 3. Hawaii, 4. South Carolina, 5. Louisiana, 6. Michigan, 7. Kentucky, 8. Vermont, 9. Alaska, and 10. Illinois.
The commercial health insurance market in 27 states became more concentrated between 2014 and 2016.
The 10 states that experienced the largest increase in market concentration between 2014 and 2016 were: 1. Kentucky, 2. Alaska, 3. South Carolina, 4. Mississippi, 5. South Dakota, 6.Oklahoma, 7. Vermont, 8. Arkansas, 9. Nevada and 10. New Mexico.

Competition in Health Insurance: A Comprehensive Study of U.S. Markets is free to AMA members. The study is also available to non-members. To order a copy, visit the online AMA Store, or call (800) 621-8335 and mention item number OP427117.

Editor’s Note: Credentialed members of the media can obtain a free copy of the AMA’s newest study on competition in the nation’s health insurance industry by contacting AMA Media & Editorial at: (312) 464-4430.

Tags: AMA, commercial, exchange, health, HMO, Insurance, market, PPO. POS, study

Posted in: Insurance

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Tentative Bipartisan Deal Reached to Restore CSR Payments

Posted by admin on October 20, 2017

Earlier this week, the U.S. Senate reached a bipartisan deal “in principle” to restore Obamacare cost-sharing reduction payments for two years in exchange for more state flexibility in the health care act. The proposed plan would also restore more than $100 million in funding for health care outreach.

The bipartisan bill gained momentum later in the week with 24 co-sponsors to the legislation. President Trump has suggested he was “open” to authorizing payments to insurers that help offset out-of-pocket health costs in the short term — but had not given up his goal of repealing the ACA.

The short-term solution would allow insurers to offer catastrophic insurance plans to consumers ages 30 and older on the exchanges, while maintaining a single-risk pool, meanwhile also making it easier for states to obtain waivers to customize health plan rules to their needs by speeding up administration approval of the waivers and allow states to copy provisions in waivers that were already approved. This could also provide a reprieve for the Affordable Care Act that would prevent 2018 premiums from increasing as much as previously predicted. However, consumers in many states will still face double-digit rate increases, and in many counties, health plans will be available from only one insurance company.

The proposed legislation would not allow states to change the essential benefits insurers are now required to offer individuals and small businesses under the ACA or let insurers discriminate against consumers with preexisting conditions for the next two years.

The Medical Association will continue to monitor the progress of this proposed legislation and is eager to work with lawmakers toward a positive solution.

Tags: ACA, cost, Insurance, obamacare, premium, reduction, share

Posted in: Advocacy

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Pres. Trump’s Executive Order Creates Confusion

Posted by admin on October 13, 2017

Earlier this week, President Trump signed an executive order that could be a first step in dismantling the Affordable Care Act. About 20 health organizations have so far spoken out against the executive order arguing the action could weaken patient protections and destabilize the individual market.

President Trump’s executive order signed on Thursday, Oct. 12, does not implement any policies, but it does request federal agencies such as the Department of Health and Human Services and the Department of Labor to develop regulations to expand the use of association health plans, which allow small businesses to join forces to purchase health coverage together, as well as to expand the definition of short-term insurance, which typically offers less coverage and comes with higher out-of-pocket costs.

The order issues three primary directives to federal agencies:

Consider ways to expand access to association health plans, potentially allowing employers to purchase insurance across state lines.
Consider expanding coverage through short-term health insurance plans, which are not subject to the Affordable Care Act’s regulations such as minimum coverage requirements.
Consider changes to health reimbursement arrangements (HRAs) — employer-funded accounts that reimburse workers for healthcare expenses — to allow employers to make better use of them.

During a press conference, President Trump said expanding use of association health plans would increase competition and allow more small businesses to have the same purchasing options as larger employers. He said he also plans to eliminate the three-month limit on short-term health insurance plans.

“The Medical Association is in the process of reviewing the President’s Executive Order and is consulting with industry experts to get a full understanding of the downstream effects the order will have on patient care. There is some concern that the order could erode important patient protections, which would be a serious issue however the true impact is unclear at this point,” Executive Director Mark Jackson said.

The executive order does not make policy changes itself, any new rules will go through a notice and comment period that could take months.

In a decision that coincided with the executive order, the White House has confirmed that it will stop federal payments for cost-sharing reductions to health insurers. These payments help insurers pay out-of-pocket costs for low-income individuals purchasing coverage through the exchanges. If stopped, premiums could dramatically rise and cause insurance companies to leave the exchanges and challenge the decision in court. There’s confusion as to when the payments, which could total about $9 billion this year, would end.

Tags: exchange, health, HRA, Insurance, order, plan

Posted in: Advocacy

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UPDATE: Lawmakers Back to the Drawing Board for CHIP Funding Renewal

Posted by admin on October 6, 2017

UPDATED OCT. 12, 2017 — Legislation to renew funding for the Children’s Health Insurance Program has stalled in the U.S. House as lawmakers continue debating how to pay for the program. This is the third delay requested by the Democrats as the lawmakers now work to mark up the legislation to extend funding for critical programs other than CHIP, such as Community Health Centers and to provide an additional $1 billion to Puerto Rico’s Medicaid program.

Both parties agree on the urgency of passing a CHIP bill. Federal funding for the program expired Sept. 30, and the longer Congress delays taking action, the tougher it will be on states.

Eleven states anticipate they will burn through their federal funding by the end of 2017, according to the Kaiser Family Foundation, and 32 states project they will exhaust federal funds by the end of March 2018.

Click here to read House Energy and Commerce Committee Chairman Greg Walden’s Statement on CHIP and Extending Critical Public Health Programs

OCTOBER 6, 2017 — After being unable to come together to meet a Sept. 30 deadline that would have renewed funding for the Children’s Health Insurance Program for five years, lawmakers in Washington were back at the drawing board this week looking for solutions to ensure federal funding for CHIP even though the Senate Finance Committee reached a bipartisan deal in mid-September to extend funding for five years.

Earlier in September, the U.S. Senate Finance Committee reached an estimated $8 billion bipartisan agreement to renew CHIP funding for five years and phase out the 23 percent Obamacare funding bump. States would have maintained eligibility through 2019, and after that there would be no so-called maintenance of effort for children of parents with incomes more than 300 percent of the federal poverty level.

The Medicaid and CHIP Payment and Access Commission has estimated that all states will exhaust their federal CHIP reserves in 2018 without an extension but warns that an extension alone will not be enough.

“If Congress extends funding but does not include the 23 percentage-point increase in the federal matching rate that was provided in the ACA, most states will still face shortfalls, since many assumed continued funding with the enhanced match rate,” it noted.

In Alabama, CHIP funding is split between Alabama Medicaid and the Alabama Department of Public Health. ADPH administers the ALL Kids program, which covers about 83,000 of Alabama’s children, while Medicaid provides covers for an additional 70,000 children.

The Medical Association, the Alabama Chapter of the American Academy of Pediatrics, state lawmakers and a number of organizations advocating for children’s health care petitioned the Alabama Congressional Delegation to support reauthorization of a bipartisan CHIP funding bill before the Sept. 30 deadline. In a letter to the Alabama Congressional Delegation outlining support for CHIP reauthorization, the coalition cited the great strides made possible through CHIP in ensuring children have access to the care they need. As well, any reductions in federal CHIP funding could cause problems for not only Alabama’s ALL Kids program but also children enrolled in Alabama Medicaid.

Tags: children, CHIP, fund, Insurance, kids, Medicaid, pediatric

Posted in: CHIP

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U.S. Senate Announces 5-Year CHIP Funding Program

Posted by admin on September 14, 2017

The U.S. Senate Finance Committee reached an estimated $8 billion bipartisan agreement that renews funding for the Children’s Health Insurance Program for five years and phases out the 23 percent Obamacare funding bump. States would have to maintain eligibility through 2019, and after that there would be no so-called maintenance of effort for children of parents with incomes more than 300 percent of the federal poverty level.

While the deal does not include details of how the Congress would pay for the funding extension, the proposed legislation would maintain Obamacare’s 23 percent increase in the federal matching rate to states for 2018 and 2019 and begin to ratchet it down in 2020, according to GOP and Democratic aides. The bump is set at 11.5 percent in 2020 and would be totally eliminated starting in 2021. Amendments to the proposed legislation are expected.

“The Medical Association began working with Alabama’s Congressional Delegation in January when we traveled to Washington, D.C., for the Government Relations Conference,” said Executive Director Mark Jackson. “We wanted to express to them the importance that CHIP funding be renewed and the impact the program has on our residents. We are pleased to see that there is a bi-partisan proposal in the Senate that will keep CHIP funding in place.”

CHIP is authorized through 2019, but funding runs out at the end of September. CHIP covers families with income levels between 138 percent and 405 percent of the federal poverty level. States determine the eligibility levels within those parameters, and the ACA requires that states maintain eligibility levels that were in place as of March 23, 2010. States that reduce eligibility lose federal Medicaid funding. Eligibility levels are capped between 200 percent and 300 percent of poverty in 30 states, and in 19 states eligibility levels are higher than 300 percent of poverty, although those states don’t receive the higher match rate for enrollees above the 300 percent threshold, according to American Action Forum. The Finance deal would let states drop eligibility levels to 300 percent of poverty after 2019.

More than 97 percent of CHIP enrollees have family income of 250 percent of poverty, according to the American Action Forum analysis.

The American Academy of Family Physicians and more than 130 other organizations issued a statement on Sept. 6 calling on legislators to save the CHIP from chaos and families from confusion by extending the program’s funding for five years before it expires on Sept. 30.

“CHIP has a proven track record of providing high-quality, cost-effective coverage for low-income children and pregnant women in working families,” the statement said. “CHIP was a smart, bipartisan solution to a real problem facing American children and families when it was adopted in 1997, and its importance and impact in securing a healthy future for children in low-income families has only increased. As Congress continues to work on larger health system reforms, a primary goal should be to improve health coverage for children, but at a minimum, no child should be left worse off. We urge our nation’s leaders to work together to enact a five-year extension of CHIP funding as an important opportunity for meaningful, bipartisan action.”

Nearly 9 million children whose families could not otherwise afford health insurance have access to health care because of CHIP. The program also enables pregnant women in 19 states to obtain the health care they need to have healthy pregnancies and give birth to healthy infants. Many families covered by the program have incomes too high to qualify for Medicaid.

Tags: CHIP, Insurance, Medicaid

Posted in: CHIP

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The Medical Association Supports Replacement of ACA with Workable Health Care System

Posted by admin on July 28, 2017

The Medical Association released its 2017 Legislative Agendas earlier this year, which were developed with guidance from the House of Delegates and great contribution from our physician members who participated in the 2017 Legislative Agenda Survey. The Medical Association has continued to express support for the repeal of the Affordable Care Act and its replacement with an adequate system to protect not only physicians but their patients as well.

The U.S. Senate is engaged in deliberations on legislation to repeal and replace the Affordable Care Act. So far these debates have one thing in common – they fail to meet the basic requirements of a solid health care plan, which does not further damage an already weakened Medicaid program or make it more difficult for low and moderate-income Americans to obtain affordable health insurance.

As from the beginning, Medical Association continues to support the repeal of the Affordable Care Act and replacement with a system that:

Includes meaningful tort reforms that maintain existing state protections
Preserves employer-based health insurance
Protects coverage for patients with pre-existing conditions
Protects coverage for dependents under age 26
With proper oversight, allows the sale of health insurance across state lines
Allows for deducting individual health insurance expenses on tax returns
Increases allowed contributions to health savings accounts
Ensures access for vulnerable populations
Ensures universal, catastrophic coverage
Does not increase uncompensated care
Does not require adherence with insurance requirements until insurance reimbursement begins
Reduces administrative and regulatory burdens

The disproportionate funding model dictated by the ACA has left most states, including Alabama, sorely underfunded. Medicaid is a critical component of our health care system, covering the young and elderly. Medicaid covers more than half of Alabama births and 47 percent of our children, as well as 60 percent of Alabama’s nursing home residents. Without full funding, the Medicaid program will collapse, leaving these individuals without coverage. While uncompensated care is delivered every day in all 67 counties of this state, without Medicaid, charity care needs could skyrocket, crippling the health care delivery system and potentially placing the burden on those with private health insurance through higher premiums and co-pays.

Now’s the time to fix our broken health care system to ensure access to care for our citizens and the ability for physicians to practice medicine without overwhelming federal burdens guiding the way. The Medical Association continues to work with our Congressional Delegation during these negotiations and urges them to work together toward the passage of a viable health care solution for our residents.

Tags: ACA, congress, health, healthcare, Insurance, Medicaid, obamacare, repeal, replace

Posted in: Advocacy

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Emergency Physicians: Georgia BCBS Policy Violates Federal Law

Posted by admin on June 2, 2017

WASHINGTON, DC – The American College of Emergency Physicians and its Georgia Chapter recently announced a policy that Blue Cross/Blue Shield of Georgia plans to implement in July, making subscribers pay for any emergency department visit that turns out not to be an emergency, violates the “prudent layperson” standard, which is codified in federal law, including the Affordable Care Act. It’s also the law in more than 30 states.

The “prudent layperson” standard requires that insurance coverage be based on a patient’s symptoms, not their final diagnosis. Anyone who seeks emergency care suffering from symptoms that appear to be an emergency, such as chest pain, cannot be denied coverage even if the final diagnosis does not turn out to be an emergency. It also prohibits insurance companies from requiring patients to get prior authorization before seeking emergency care.

“This new policy will mean that patients experiencing emergencies will not go to the ER because of fear of a bill, and could die as a result,” said Rebecca Parker, MD, FACEP, president of ACEP. “Health plans have a long history of not paying for emergency care. Now, they are trying to roll over federal law that emergency physicians fought for to protect patients from this ‘profits first, people last’ behavior by insurers.”

In the new policy, final diagnoses that BCBS considers to be “non-urgent” would not be covered if the patient goes to the emergency department, leaving patients to decide whether they are experiencing an emergency. A 2013 study in JAMA found a nearly 90 percent overlap in symptoms between emergencies and non-emergencies.

“This policy threatens the safety of all Georgians,” said Matt Lyon, MD, FACEP, president of Georgia’s ACEP Chapter. “We treat patients every day with identical symptoms – some get to go home and some go to surgery. There is no way for patients to know which symptoms are life-threatening and which ones are not. Only a full medical work-up can determine that.”

Dr. Lyon adds that this action will be especially bad for Georgia’s rural population, where citizens are often limited in their options for medical care.

“If patients think they have the symptoms of a medical emergency, they should seek emergency care immediately,” said Dr. Parker. “The vast majority of emergency patients seek care appropriately, according to the CDC. Patients cannot be expected to self-diagnose their medical conditions, which is why the prudent layperson standard must continue to be included in any replacement legislation of the Affordable Care Act.”

ACEP is the national medical specialty society representing emergency medicine. ACEP is committed to advancing emergency care through continuing education, research and public education. Headquartered in Dallas, Texas, ACEP has 53 chapters representing each state, as well as Puerto Rico and the District of Columbia. A Government Services Chapter represents emergency physicians employed by military branches and other government agencies.

Tags: coverage, emergency, Insurance, law, research

Posted in: Legal Watch

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What You Need to Know about the Business of Practicing Medicine

Posted by admin on April 7, 2017

While physicians today learn cutting-edge medical treatments and technologies, most of them don’t receive any instruction on the business side of medicine. That’s an unfortunate omission; practicing medicine requires doctors to enter contracts, to be aware of applicable rules, laws and regulations, to market themselves, to understand proper coding requirements, and to properly collect patient payments.

Today we will focus on one of the first business documents a physician will encounter: a contract with a physician practice. What subjects will it cover? What questions can you ask? Should you get a professional to look at the document?

Compensation is one item that will be addressed in the contract. Be sure you understand how your compensation is determined, whether you have the opportunity to earn a bonus, and exactly what a bonus will be based on. You may be offered a trial period to practice as a salaried physician (perhaps one to three years) before you can join the practice as a partner.

Don’t be afraid to ask questions. If you are required to work as a salaried physician for a time, how does the practice decide whether or not to offer you a partnership? What has happened to physicians who have come before you? Has anyone failed to make partner, and if so, what were the reasons?

If you are fortunate enough to be considering competing offers, don’t look at salaries in a vacuum. A quick online search will reveal the average income of a physician in your specialty in the city you are considering. Similarly, you can search and compare the cost of living in different cities. A slightly lower offer may go farther in a city with a much lower cost of living.

Do not forget to factor in benefits as well. A practice that pays for your CME, malpractice insurance, health and disability insurance, and makes generous contributions to your retirement account is relieving you from paying thousands of dollars per month.

OnBoard Healthcare is a partner of the Medical Association. Visit them online for more information.

Tags: compensation, Insurance, law, partner, rules

Posted in: Management

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Are Tax Cuts Coming for the Small Business Owner?

Posted by admin on March 24, 2017

While physician practices have many specialized health care compliance issues, most are, in essence, small businesses that face the same challenges as any small business. Taxes and regulations are among those challenges affecting all small businesses. And many owners are now eagerly awaiting alleviation of those challenges.

According to the National Federation of Independent Business, small business optimism is at its highest rate since 2004. Small business owners are hopeful that President Trump’s promises of regulatory reform and lower taxes will become a reality, and small businesses will reap the rewards. With Republicans controlling both Houses, that hope appears to be well-founded.

President Trump and the Republican Congress have promised that a repeal of the Affordable Care Act will lower insurance requirements for small businesses, that the deconstruction of the banking regulations of the Dodd-Frank Act will give small businesses more access to credit, and that tax reform will provide small businesses with tax savings. Let’s take a look at some of the specific tax plans President Trump has proposed that have small business owners excited.

Small business owners are hopeful that President Trump’s promises or regulatory reform and lower taxes will become a reality and small businesses will reap the rewards. Small business owners should rightly expect to see tax cuts in the near future.

The new administration has proposed cutting the highest corporate tax rate from 35 percent to 15 percent. S corporations and other pass-through entities may also see a reduced tax rate, as President Trump has proposed a maximum rate of 15 percent on business income that is reinvested into the company. This proposal provides some relief to the business owner on his “phantom income” tax bill. Comparatively, the House GOP tax plan reduces the corporate rate to 20 percent and the pass-through rate to 25 percent.

Of course, small business owners are also individual taxpayers, and President Trump’s tax plan contains several facets to benefit the individual taxpayer. President Trump’s proposal is to reduce the number of personal income tax brackets from seven to three. For joint filers, the proposed marginal rates on taxable income are 12 percent for up to $75,000, 25 percent for $75,000 to $225,000, and 33 percent for more than $225,000. (Dollar amounts for single filers are half of these amounts.) Here, the House GOP tax plan aligns with President Trump’s proposal, save a slight variation in the dollar amounts.

Of particular interest to many high-income earners is the Net Investment Income Tax (“NIIT”). The NIIT was enacted within the Affordable Care Act (“ACA”) and imposes a tax of 3.8 percent on investment income, such as interest, dividends, short-term and long-term capital gains, rental income, royalty income, and passive activity income. It applies only to investment income that exceeds a threshold of $200,000 of adjusted gross income for single filers and $250,000 of adjusted gross income for joint filers. President Trump, however, has proposed to repeal that tax. And because the NIIT is part of the ACA, which is first and foremost on the Republican Congress’s list of laws to repeal, this 3.8 percent tax may be the first tax to go.

President Trump’s tax plan also includes more than doubling the standard deduction, eliminating the estate tax, and providing revised childcare deductions and rebates. Additionally, he has proposed providing for the establishment of Dependent Care Savings Accounts with a government matching program.

It is worth noting, though, that President Trump has a stated goal of tax simplification. To that end, he has proposed to eliminate the reduced capital gains tax rate for carried interest, eliminate personal exemptions, eliminate the head-of-household status, and impose a cap on itemized deductions. As such, not all of President Trump’s proposed tax plan will provide a benefit to the taxpayer’s bottom line.

Even so, small business owners should be energized by the lower rates and simplification. A reduction of tax compliance expenditures could be significant for the small business. Piggyback that on the expected repeal of the Affordable Care Act, and small business owners can anticipate spending less time and effort on the compliance side and more on the business side.

Although portions of the House Republicans’ tax plan are not as aggressive as President Trump’s, the plans set forth similar reductions to the individual and business tax rates. Consequently, small business owners should rightly expect to see tax cuts in the near future.

Article contributed by Leslie H. Pitman, an attorney at Gilpin Givhan. Gilpin Givan is a Bronze Partner with the Medical Association.

Tags: business, Insurance, management, regulate, tax

Posted in: Management

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New American Health Care Act Comes Under Fire

Posted by admin on March 8, 2017

Earlier this week, members of the House Energy and Commerce Committee released legislation as part of the House Republicans’ efforts to repeal and replace Obamacare. Although the legislation cleared its first hurdle with a lengthy, contentious markup session that began Wednesday, the House Ways and Means Committee approved the American Health Care Act. The House Energy and Commerce Committee continued debating the legislation well into Thursday. Many health care organizations are speaking out against the legislation.

In brief, the 123-page legislation proposes to:

Eliminate the Obamacare taxes on job creators, increased premium costs, and limited options for patients and health care providers.
Eliminate the individual and employer mandate penalties.
Prohibit health insurers from denying coverage or charging more to patients based on pre-existing conditions.
Help young adults access health insurance and stabilize the marketplace by allowing dependents to continue staying on their parents’ plan until they are 26.
Establish a Patient and State Stability Fund, which provides states with $100 billion to design programs that meet the unique needs of their patient populations and help low-income Americans afford health care.
Modernize and strengthen Medicaid by transitioning to a “per capita allotment” so states can better serve the patients most in need.
Empower individuals and families to spend their health care dollars the way they want and need by enhancing and expanding Health Savings Accounts (HSAs).
Help Americans access affordable, quality health care by providing a monthly tax credit for low- and middle-income individuals and families who don’t receive insurance through work or a government program.

Although Democrats and Republicans are beginning to speak against the bill, perhaps most critical of the legislation has been the American Medical Association, which issued a letter to congressional leaders stating that it cannot support the bill.

“While we agree that there are problems with the ACA that must be addressed, we cannot support the AHCA as drafted because of the expected decline in health insurance coverage and the potential harm it would cause to vulnerable patient populations,” it said.

AMA President Dr. Andrew Gurman introduced the letter on the AMA’s website by stating: “We all know that our health system is highly complex, but our core commitment to the patients most in need should be straightforward. As the AMA has previously stated, members of Congress must keep top of mind the potentially life-altering impact their policy decisions will have.”

Similarly, the American Nurses Association and the American Hospital Association have expressed strong opposition to the proposed American Health Care Act citing fundamental changes in Medicare and Medicaid, which the groups argue could limit access to care while “in no way improving care.”

“It appears that the effort to restructure the Medicaid program will have the effect of making significant reductions in a program that provides services to our most vulnerable populations,” wrote Richard Pollack, CEO and president of the American Hospital Association, in his letter to members of Congress.

The legislation does not yet have a score from the Congressional Budget Office, which could provide an estimate of the bill’s cost and impact on coverage levels. However, White House representatives have indicated a score will soon be released.

Other medical groups are expressing concern about the speed at which the bill appears to be moving.

“We are concerned that by rushing to a mark-up … in the Energy and Commerce and Ways and Means Committees, there will be insufficient time to obtain non-partisan estimates of this legislation’s impact by the Congressional Budget Office, or for medical organizations like ours and other key stakeholders in the health care community to offer substantive input on the bill,” the American Academy of Family Physicians, American Academy of Pediatrics, American College of Physicians, American Congress of Obstetricians and Gynecologists: and the American Osteopathic Association said in a joint statement.

Click here for a look at what the American Health Care Act would keep, change and/or repeal versus the ACA.