George A. Williams, MD ~ Impressions on New HHS Secretary & The Latest Healthcare Update: Repeal or Replace?

The daily heated debates between the Democrats and Republicans will continue as we receive the latest updates on healthcare from the national media. In May 2016, RetinaLink posted Dr. George Williams’ interview about Obamacare, his thoughts about 2016 election and depending on the outcome of the election, Democratic or Republican win, would effect Obamacare? Now, with the historical election behind us, Dr. Williams provides his insight on potential healthcare changes with the new Administration now in place. Dr. Williams is the American Academy of Ophthalmology’s Secretary for Federal Affairs and the Academy’s delegate to the RUC. He also serves as the Chair of the Ophthalmic Mutual Insurance Company.

RetinaLink spoke to George A. Williams, MD, who is a partner with Associated Retinal Consultants and Chairman of the Department of Ophthalmology, Oakland University William Beaumont School of Medicine, Royal Oak, Michigan to gain some clarity on what may happen with ACA, Affordable Care Act. We framed our conversation with May 2016’s question on where healthcare was going prior to the election.

MAY 2016 ~ RetinaLink (RL): Where do you see Healthcare going after the November election? Will there be a repeal of Obamacare whether the Democrats or the Republicans win the upcoming election?
George A. Williams, MD (GAW): Obamacare will never be repealed. There will be some changes and tweaks, but The Supreme Court has spoken and it is now the Law of the Land. Let’s take a moment and look at healthcare historically… Many in health care fought tooth and nail to prevent Medicare and now we can’t imagine practicing without it. Eventually, Obamacare will become the norm. We have a moral obligation as a country to provide healthcare to everyone.

Very few government programs remain unchanged, and certainly the ACA or Obamacare is no exception. Regardless of who becomes President, at most there will be incremental changes. Actually, I am more concerned about the long-term effects of MACRA on physician payment and practice models. Remember that unlike the ACA, MACRA was passed by large, bipartisan majorities in response to the call for an SGR fix. Well, it now looks like a case of careful what you ask for. It is becoming increasingly clear that fee-for-service payment in a private practice setting is an endangered species. The recently released proposals for MIPS and alternative payments models (APM) are a deliberate attempt to drive physicians, and particularly specialists, into institutional based practice.

MARCH 2017 ~ (GAW): I was completely wrong but, then again most people were completely wrong. It now appears Obamacare will be repealed and replaced with an alternative plan. The Republican house bill does cut costs; however, increases the number of uninsured.

Whether or not the Republicans plan survives the Senate remains to be seen. The real problem continues to be adverse selection. What is adverse selection? More sick people than healthy people signed up for the healthcare exchanges under Obamacare.

The Republican plan may decrease incentives to obtain health insurance. If so, this could further aggravate adverse selection. However, the recent Congressional Budget Office, CBO, analysis does not forecast destabilization of the insurance market. Therefore, it remains unclear how this will play out in the long run. It’s important to note that this is the same CBO that overestimated the number of people that received coverage with Obamacare. As I mentioned previously, the Republican plan is likely to increase the number of uninsured over the next several years.

RL: With the election now behind us, what are your thoughts on Obamacare being modified? If it’s modified, can certain provisions be “cherry picked?” For example, we continue to hear that pre-existing conditions may be included for patients.

GAW: The Affordable Care Act hasn’t been affordable. We have seen a double digit increase of insurance premiums and as a result many patients deciding they would rather pay the penalty vs. obtaining coverage.

There are some features of the ACA that are positive and they include:

1) The pre-existing conditions provision is popular and popular opinion is in favor of keeping it. Patients
should not be prevented from medical underwriting.

2) No limits clause:
Some policies are written with a cap of $ 1 million or $ 2 million dollars. If you are really ill, you may
easily exceed that coverage maximum.

3) Children under the age of 26-years-old:
This goes back to our adverse selection discussion that prevents people from requiring insurance. You
are asking them to pay for insurance when they are young and healthy. You are providing insurance;
however, it doesn’t have the proper funding because people don’t want to pay for something that won’t
happen to them. It doesn’t make sense to provide insurance to only patients who need coverage. You
must have the healthy patients to mitigate the risk. That’s been the “ongoing” death spiral for
Obamacare.

The proposed Republican plan is to move healthcare to the private sector as much as possible. Speaker of the House, Paul Ryan, has outlined one possibility could be a voucher system provided by government. Then, each person/family would review their need vs. having to choose a certain level of coverage. The potential issue with this plan is underinsured lives.

The Republicans intent is send Medicaid control back to the states. They would prefer to establish block grants to take care of patients. Basically, here’s your funding and this would allow Medicaid to return to “patient and state centered” care. The concern continues to be certain states understand the proper level of care like Massachusetts and New York. Other states like Michigan provide marginal Medicaid and then, others have substandard Medicaid services.

RL: Is there any insight/speculation moving forward on how President Trump and his newly appointed Secretary of Health & Human Services, HHS, Thomas Price, MD will change Obamacare since he was a critic of Obama’s healthcare policy?

GAW: Dr. Tom Price has a long history in healthcare. His training is in orthopedics and he practiced medicine for 20 years at Emory. It’s certainly a novel concept to have a physician as the HHS, because he actually understands what its like to take care of patients. I’m very pleased he will be our boss. Dr. Price has a very clear understanding of the problems associated with Obamacare. I believe substantial changes are likely. Dr. Price’s position is that HHS is a “regulatory apparatus”. This “regulatory apparatus” creates impediments to efficient and effective patient care. Dr. Price is a good friend to Ophthalmology and received the AAO Visionary Award in 2015. His HHS appointment allows us significant access. The AAO has already had the opportunity to meet with Dr. Price to discuss a variety of issues. Dr. Price may not always agree with us; however, he’s willing to listen. Listening is unprecedented and its certainly positive to have access to him at HHS. Overall, Dr. Price’s appointment is great for both medicine and ophthalmology.

I’m very optimistic because we finally have the opportunity to eliminate some of this bureaucratic nonsense and minimize the regulatory burden. The proposed MACRA program is unduly burdensome and unlikely to improve patient care. We need a new system that will improve care and value. Obviously, we’ll wait and see what the future holds. We may be on the verge of a turning point that returns control of medical care to physicians and patients.

George A. Williams, MD can be reached via e-mail George.Williams@Beaumont.edu.

 

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