MDLinx readers share thoughts on the Patient Freedom Act of 2017

The Patient Freedom Act of 2017—co-sponsored by US Senators Linsey Graham (R-SC), Bill Cassidy (R-LA), Susan Collins (R-ME), Shelley Moore Capito (R-WV), and Johnny Isakson (R-GA)—is touted as a comprehensive replacement plan for Obamacare. The plan has been designed to provide better choices and increase access to affordable health care for all Americans, and transfer power from Washington back to patients and the states.

The proposal also seeks to eliminate costly mandates, simplify enrollment, require price transparency, and restore state authority to set rules for their health insurance markets, as well as give patients the power to make their own health care decisions.

Through SurveyGizmo, MDLinx conducted a survey of readers who read the original release posted in MDLinx Washington Report. In all, 106 readers responded to the survey.

The majority of respondents (41.0%) considered themselves Independent, followed by 25.7% registered Republicans, 19.0% registered Democrats, and 14.3% preferred not to say. Regionally, the respondents’ practices were evenly distributed throughout the country: 25% each in the Southwest, Northeast, Midwest and Southeast.

Most not in favor of Patient Freedom Act

Overall, survey results showed that most respondents did not have a favorable view about the impact the Patient Freedom Act would have on their practices. For example, when asked about the possibility of state run regulations in health care having a meaningful impact on their practices, responders were mostly negative, with a full 39% responding that it will be bad for their practices, 21.4% not believing regulations will make a difference, 22.3% did not know yet, and 17.5% were positive regulations would be good for their practices.

Comments varied greatly, with many clinicians having little faith in their states’ abilities to implement such a plan. Some comments included:

• “Some states will have excellent plans, but other states will not. All states need to supply excellent, proper mandatory health coverage for all.”
• “States will be less likely to be able to implement this, and some states will end up with worse coverage than others, especially rural areas.”
• “States have not done a good job previously, why do we think it will be different now?”
• “Critical that all patients are adequately covered. Previous experience is that state-run initiatives wind up excluding the poor.”

Who should regulate health care?

Overall, most respondents believed that medical coverage should be 100% regulated by the Federal Government, although they were closely followed by those who favored light regulation for safety with the free market dictating needs and prices. A very small percentage believed that medical coverage should be completely regulated by individual states. Below is the breakdown of how responses varied:

• 36% reported that medical coverage should be 100% regulated by the Federal Government;
• 32.4% reported medical coverage should be lightly regulated for safety, but let the free market decide what subscribers want and what they are willing to pay;
• 26.7% answered that medical coverage should be regulated by the state, with some overarching federal rules; and
• Only 4.8% responded that medical coverage should be 100% regulated by the individual states.

Comments to these questions also varied widely, and included the following:

• “At least a minimum coverage level needs to be set nationally.”
• “I am a big believer in social medicine.”
• “People should have comprehensive government-supported health care that is equal, regardless of what state people live in.”
• “Single payer system—get rid of the insurance companies.”
• “Subscribers should be able to choose what type of plans most likely would fit their needs and what they're willing to pay for. At the federal or state level, monitorization should be done only to make sure that there [are] enough insurance companies and plans available to help ensure more competition to keep costs of plans down.”

Most important to include

Survey results showed that including no penalties for pre-existing conditions was of paramount importance to most clinician responders, and pricing publication was the least important.

When asked about what the most important component of the Patient Freedom Act of 2017 was, a full 60.0% responded that no penalties for pre-existing conditions were most important, followed by 18.0% who chose freedom of choice for patients via funding of a Roth Health Savings Account (HSA) directly to the patient as most important, followed by no limits on lifetime coverage (9.0%), limiting the expansion of Medicaid (7.0%), and the publication of pricing for services (6.0%).

Respondent comments included the following:

• “I think it is a terrible bill, there should be no caps, no preexisting condition penalties, no price gouging by age, and no free riders. I personally delivered $1.6 million dollars in uncompensated care.”
• “I would actually give equal importance to no lifetime limits and no penalty for preexisting conditions.”
• “The Roth Savings Account provision is the most dangerous provision of the proposed act. It would result in bankruptcy for thousands, possibly millions, of patients.”
• “The positive aspects of the ACA (coverage for preexisting conditions, [coverage for] students to age 26, contraceptive coverage, etc.) are important to bring forward in any new plan. Transparency in cost is a huge factor. Some costs are available to consumers now, but it is such a difficult process that many consumers don't look, or don't know it is available. If there was a way to see at a glance the cost of a CBC at lab A and B Or C, we could level set costs and bring overall healthcare costs down to a reasonable level. “
• “No limits on lifetime coverage and no penalties for preexisting conditions are the two most beneficial”

Respondents also had strong opinions about the irrelevance of political affiliation on patient care and the practice of health care. One participant wrote, “I am a human being who cares for my patients; it doesn't matter what political party I am part of, all need proper access to health care.”

Another wrote: “Political affiliations should not come into play when it comes to healthcare needs. This is about what's best to take care of patients. I see too many people not getting the care that they need because they don't have the means to pay for the high deductible.”

Still another had this summation: "Universal healthcare and medical costs will only be provided by a single payer system. we are alone among advanced countries in provision of healthcare, paying 3 times more without caring for the less fortunate."