From the desk of Thomas M. Priselac, Cedars-Sinai President and CEO:

The U.S. Senate is currently drafting legislation intended to repeal and replace the Affordable Care Act (Obamacare) following last month's passage by the House of Representatives of the American Health Care Act (AHCA). The recently released analysis by the nonpartisan Congressional Budget Office of the effects of the American Health Care Act is cause for serious concern:

• As early as next year, 14 million Americans would lose their health insurance.
• Within nine years, as many as 23 million Americans would have lost health insurance coverage.
• By 2020, one out of every six Americans would live in a state that elects to opt out of protections for those with pre-existing conditions.
• Medicaid (Medi-Cal in California), the program that funds healthcare for disabled and low-income Americans (and which currently covers one of every two children in California) would be cut by $834 billion over 10 years.

The president and CEO of the Robert Wood Johnson Foundation, Richard Besser, MD, recently summed it up well: "The prospect of 23 million Americans losing health insurance coverage is a significant step backward for the health of our citizens." Significant opposition to the AHCA has been expressed by a broad cross-section of both provider and consumer groups.

The Affordable Care Act is not perfect, as has been acknowledged from the beginning by its supporters. It is unrealistic to think that any issue as complex as healthcare can be completely addressed in a single piece of legislation. But, most importantly, the Affordable Care Act significantly advanced the crucial, fundamental issue of creating meaningful coverage for all Americans. It also set in motion the kind of payment and delivery system reforms needed to create the high-quality, cost-effective medical care system Americans expect. There is certainly more work to be done in achieving these expectations, given the challenge associated with transforming such a significant aspect of the American economy that has such profound personal consequences for everyone. But adequate coverage for all Americans is absolutely foundational to being able to address cost and quality.

The current path in Congress to repeal and replace the Affordable Care Act could end up with some version of the House-passed American Health Care Act. Even the "compromises" on the American Health Care Act currently being discussed merely delay implementation of some of the act’s most objectionable aspects, which are essentially oriented to denying or limiting coverage. Denying and limiting coverage gives the appearance of saving money. But it neither saves money in the long run nor does it do anything to make healthcare more uniformly high quality or more efficient.

I am hopeful that the path in the Senate can shift the discussion from repeal and replace to repair and replace. While there are several aspects in the Affordable Care Act that need to be fixed, the AHCA or a compromise version with provisions currently under discussion would be a huge mistake — specifically because it would unnecessarily hurt millions of Americans. The critical work of changing the financing and delivery of healthcare to address the issues of quality and affordability must be built on a system that assures adequate and meaningful coverage for all Americans. There is room for plenty of state-level innovation within the current provisions of the Affordable Care Act as well as modifications that could emerge from bipartisan compromise to encourage more innovation without tearing apart the foundation established by the Affordable Care Act.

The Affordable Care Act was developed with the input and advice of all the various stakeholders in American healthcare, including patient advocacy groups, hospitals and health systems, physician groups, insurance companies and the public. In a short period of time, it has enabled millions of Americans — including many with pre-existing conditions — to gain access to insurance and to ongoing care.

Although our nation is currently polarized on many issues, accessibility to meaningful healthcare coverage should not be a partisan issue.

Sincerely,

Thomas M. Priselac