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KBIA’s Health & Wealth Desk covers the economy and health of rural and underserved communities in Missouri and beyond. The team produces a weekly radio segment, as well as in-depth features and regular blog posts. The reporting desk is funded by a grant from the University of Missouri, and the Missouri Foundation for Health.Contact the Health & Wealth desk.

American Medical Association: 'We Cannot Support' Current GOP Healthcare Plan

In a letter sent to Congress Wednesday, the American Medical Association said it could not support the American Health Care Act "as drafted." The bill was released Monday evening as congressional Republicans' replacement for the Affordable Care Act, also known as Obamacare. 

Ahead of the association's decision, KBIA sat down to talk healthcare reform with Dr. David Barbe, president-elect of the American Medical Association and a practicing physician in rural Mountain Grove, Mo. 

This interview has been condensed and edited for content and clarity. 

Dr. Barbe: "We have some fairly significantly socio-economically challenged communities in our state. We have higher than average Medicaid enrollment in Missouri, and we had, prior to the ACA, a higher than average number of uninsured in our state. When the Affordable Care Act was passed and as it became implemented, we began to see enrollment in the exchanges. 


Now, Missouri did not expand Medicaid, but through the exchanges many of the patients that I see in southern Missouri were able to get insurance that simply had not had it before. It hasn't necessarily been affordable for everyone but it has allowed for some increased coverage, and that's been really good. But there's plenty of improvement yet to be made."


Q: You're president-elect of the American Medical Association; you'll be president starting in June. On Monday, the House GOP released their proposal for the future of healthcare in the country. How does that square with what you are trying to do? 


"The proposal that the Republicans are bringing forward is, they're looking to decrease the amount of central or federal control over healthcare and they're looking to decrease the federal spending on healthcare. We, the AMA, feel that the net number of covered individuals under this proposal is probably not going to be what we have currently, and that is not something that we're eager to see."


Q: Another major change in the proposal is how Medicaid would be funded. Medicaid expansion would effectively be ended in 2020 and the funding mechanism would switch to a per capita, per enrollee allocation.


"Under the current funding formula, effectively the more money that the state is willing to put up, the more money we can draw down from the federal government. 


[The American Health Care Act is] trying to cap that. There have been two major proposals on how to do that, and we are pleased to see that they didn't propose a block grant. We think that's the most draconian way to administer the federal portion of the spend for Medicaid. 


At least the per capita allocation is somewhat flexible, up to a point — as you indicated there is a maximal cap to the a number of enrollees that a state can continue to draw down federal money for, based on a formula. So we still believe that that puts at risk the ability of the states to expand Medicaid to all that might potentially benefit from it."


Q: As the bill is currently written, can the American Medical Association support it? 


"I think it will be challenging. The proposed legislation just came out Monday night, the AMA board will actually meet at 6:00 this evening [Tuesday] and consider the merits of the proposal as it is written. 

What we do know is that there is not complete agreement even among the Republicans in Congress on this bill, so we believe that there can continue to be room for negotiation. So we will continue to advocate our policies in terms of coverage and affordability and stabilization of the insurance market and a protection for the safety net programs. We'll do our best to preserve those gains."

A curious Columbia, Mo. native, Bram Sable-Smith has documented mbira musicians in Zimbabwe, mining protests in Chile, and the St. Louis airport's tumultuous relationship with the Chinese cargo business. His reporting from Ferguson, Mo. was part of a KBIA documentary honored by the Missouri Broadcasters Association and winner of a national Edward R. Murrow Award. He comes to KBIA most recently from the Salt Institute for Documentary Studies in Portland, Maine.
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