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The AMA's Take On GOP Health Care Plan


The secret Senate Republican health care plan is no longer a secret. Details were released yesterday. Republicans want a fast-track vote on the bill by the Fourth of July recess. Here's President Trump.


DONALD TRUMP: We're putting in a plan today that's going to be negotiated. We'd love to have some Democrat support, but they're obstructionist. They'll never support. We won't get one, no matter how good it is. But we will hopefully get something done, and it will be something with heart and very meaningful.

MARTIN: That was the president speaking yesterday. At this point, Senate Republicans don't have the votes they need to pass this bill. The bill would reduce Medicaid funding and change how the program insures poor Americans, reducing subsidies and removing taxes on businesses and wealthy Americans that were put in place to help fund Obamacare.

To find out what some doctors think of the legislation, we've reached David Barbe. He is president of the American Medical Association, which represents about a quarter of a million doctors in this country. Dr. Barbe is also a practicing family doctor in Mountain Grove, Mo., which is where we reached him this morning. Dr. Barbe, welcome to the program.

DAVID BARBE: Thank you very much. Good to be with you.

MARTIN: Is this a bill you can support?

BARBE: It is not. This does all of the things that the AHCA did and will reduce coverage for individuals and will gut Medicaid.

MARTIN: AHCA being the House version of this bill. So what needs to change? I mean, do you see a path forward at this point?

BARBE: You know, we - the AMA's house of delegates met just a couple of weeks ago, and we came out very clearly opposed to caps on Medicaid funding. We think that the current system, in which Medicaid funding can vary based on the needs of a given state, is a much better program than to put arbitrary caps or block grants.

MARTIN: But - and correct me if I'm wrong. The Senate bill and the House bill, the whole gist of it was to give states more control, that the states understand how to best fund Medicaid, and so the power - responsibility was going to be given back to the states.

BARBE: So that may be true, but we give back the power to the states with a much, much smaller pool of money to work with. We have to remember, people covered by Medicaid are the most vulnerable in our society. They are the frail elderly. They are the disabled. They are adults with very low income. These individuals often have greater health needs than even an average American, and to cut funding to that program is just the wrong direction.

MARTIN: Your state, Missouri, didn't actually expand Medicaid as it could have under the Affordable Care Act. So would reductions in Medicaid cause that much pain?

BARBE: So I see every day in my practice people that are uninsured who would have been covered had Missouri expanded Medicaid. The average household income in my area of Missouri is less than half of the national average. So that lets you know that we depend very heavily on programs such as Medicaid for insurance coverage for many of the people that I take care of in my practice every day.

MARTIN: Is there anything in this bill you think is a good idea?

BARBE: You know, there are not really many parts of this that we like. If we go down the list of things - does it improve coverage? No. Does it improve affordability? No. Does it stabilize the safety net, Medicaid? No. The only thing maybe it does is, for two years, it does replace the cost-sharing payments that insurance companies get.

We are very concerned about insurance companies dropping out of the exchange market. Stabilizing that, even for a couple of years, should help. So maybe that's a tiny silver lining, but that does not offset the other cuts that are really going to be bad.

MARTIN: So in your state, there are some 25 counties with no health insurance options. People can't buy insurance outside of a company-sponsored plan. This isn't very many people because this is a very rural state, these counties in particular. But still, Republicans have used these pockets of the population to demonstrate what they say are shortcomings in Obamacare. Do you think that's accurate? Is that fair?

BARBE: That is accurate. Before these - the last insurance company pulled out of 20 counties in Missouri, there were still 97 of the 114 counties that had only one choice. The state of Iowa now - it's my understanding that 94 of their 99 counties will have no offering in the insurance exchange. So there's simply no way that those individuals can access insurance.

MARTIN: Just briefly, what now? How is your organizing - how is your organization trying to influence this process? Are you lobbying up on the Hill?

BARBE: So we are lobbying individually as the American Medical Association, but we're also partnering with many other organizations. I was in Cleveland just earlier - well, late last week - and partnered with the American Hospital Association, American Diabetic Association, American Heart Association and other groups that are interested in patient protections just as we are.

MARTIN: Dr. David Barbe, president of the American Medical Association, thanks so much.

BARBE: Thank you very much. Transcript provided by NPR, Copyright NPR.