Former ABA Health Law Section chairs offer guidance to the president on health care reform
President Donald Trump. Evan El-Amin / Shutterstock.com
Ten former chairs of the American Bar Association’s Health Law Section published a letter to President Donald Trump and congressional leaders Monday, offering their suggestions on how best to reform health care.
The letter was published on LinkedIn by 2007-2008 Health Law Section chair Andrew Demetriou. Demetriou, who represents healthcare companies in business transactions, says he chose LinkedIn because he has no website of his own, and he needed an easily shared URL. He says the goal was to share the signatories’ experience in health care law, on a nonpartisan basis.
“My thought was we’re lawyers, this is a legal matter and we wanted to offer our best ideas of what we think should be offered in reform legislation,” Demetriou, of Lamb and Kawakami in Los Angeles, told the ABA Journal.
The letter emphasizes that the writers are speaking as citizens, not for the Health Law Section, the ABA or their own employers. The letter also says its suggestions come from attorneys with a variety of political beliefs.
The letter notes that while public debate has focused on a few highly debated provisions of the Affordable Care Act—popularly called “Obamacare”—the law has many other provisions that if repealed could hurt both the health care business and ordinary patients. A full repeal could eliminate less-noticed provisions that improve health care overall, the writers say, and it would also disrupt substantial financial decisions made with the understanding that the ACA would continue to exist.
The letter suggests 16 principles that writers believe should influence any new legislation, including:
- Legislation should respect the investments made in the ACA, and changes should be phased in gradually to avoid creating “stranded assets” for providers, insurers and government. Individual coverage and subsidies should continue through 2019, and individuals should get enough notice about changes to make informed decisions.
- Lawmakers should use incentives rather than penalties to encourage the desired behavior. If employer and individual mandates are eliminated, they should be replaced with incentives encouraging individuals and employers to maintain coverage.
- States with exchanges that are working well should be permitted to keep them; federal exchanges should be kept until states create exchanges or there’s an adequate individual market. High-risk pools should be encouraged.
- If Medicaid funding is converted to block grants, those grants should be large enough to permit states to continue their programs. Those states that did not expand Medicaid should be incentivized to develop other coverage programs.
- ACA taxes and penalties should be repealed only if there are other tax reforms that adequately fund programs that survive reform.
- Transparency provisions on issues like pharmaceutical companies’ payments to doctors should be retained. Anti-corruption provisions should be rewritten to recognize changes in financial relationships among parties in the health care industry.
- Requirements for parity in mental health and substance abuse care should be retained.
The letter ends with an offer to help political leaders with health care reform, should the signatories’ expertise be required. Signatories, in addition to Demetriou, include Linda A. Baumann, William Horton, Bonnie Brier, David H. Johnson, Paul R. Demuro, David Douglass, David Hilgers, Gregory Pemberton and Howard T. Wall III. All have been chair of the Health Law Section since 2000. A few former section chairs Demetriou spoke to were “sympathetic,” he says, but couldn’t sign on for reasons related to their employment.
“We appreciate the challenges involved in developing legislation to address this important national priority,” the letter says. “As [the president has] recently noted, the issues around reform to the laws which govern healthcare delivery are “unbelievably complex,” but they are well understood by the signatories of this letter and other individuals with whom we work on a daily basis.”
