Prominent Health Lawyers Tell Trump to Save Critical Obamacare Components

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By Matthew Loughran

A group of 10 prominent health-care attorneys told President Donald Trump and key members of Congress to maintain Affordable Care Act program components that have been critical to expanding health insurance coverage and protecting the viability of health-care institutions.

The March 13 letter, signed by 10 of the last 17 individuals to chair the American Bar Association’s Health Law Section, urges a deliberate approach to Obamacare repeal and replacement that respects that the health-care industry and government agencies have spent billions of dollars to implement the ACA, including the development of insurance exchanges; investment in accountable care organizations, medical homes and other value-based health-care delivery models; and adoption of electronic medical record systems.

The letter, sent at the height of deliberations over the newest Obamacare replacement proposal, could get the attention of GOP policyholders because it reflects the views of a bipartisan group of experienced health lawyers with a broad health-care industry perspective.

The lawyers, who call their group Health Lawyers for Responsible Reform, suggest many of the programs included in the ACA should be retained as part of reform efforts. Among other suggestions, they advocate continuing to allow insurance coverage and underwriting reforms mandated by the ACA, including the ban on coverage denial for preexisting conditions and elimination of caps on lifetime benefits.

“What we are really trying to do is to make a plea for some positive principles in the debate over repeal and replacement of the ACA,” Andrew J. Demetriou, a health-care attorney in Los Angeles and a signatory to the letter, told Bloomberg BNA.

Group Seeks Bipartisan Approach to Replacement

Demetriou, who organized the group and who served as the ABA Health Law Section Chair from 2007 to 2008, said the letter was meant as a bipartisan effort to address aspects of repealing and replacing the ACA which he and his colleagues worried weren’t being discussed.

“This isn’t going to be something that Democrats in Congress are going to be able to wave around and point to as a condemnation of the replacement efforts, because there are a lot of things in there they aren’t going to like,” he said. “However, it also doesn’t endorse a lot of the American Health Care Act, because there are a lot of problems with that,” he added.

Demetriou said his group’s letter was meant to “lay down some markers about Medicare and other aspects of the ACA that aren’t addressed in the AHCA.” He pointed out the AHCA includes nothing about Medicare or accountable care organizations or many of the other innovations of the ACA that hospitals and insurers have invested in since the law took effect.

Demetriou said he and his colleagues were concerned the debate over repeal of the ACA had become too “facile” in the days after the inauguration. “We needed to examine holistically what works and what doesn’t,” he said.

He added that the group of attorneys who agreed to be part of the effort reflected diverse political positions and hailed from different parts of the country, which gave them the ability to find compromises and not be wedded to one political opinion or another. “This group of attorneys is really a group of people I trust and I have enormous respect for their judgment,” Demetriou said. “They are really thoughtful people and the message to Congress and the president is that we would like to help in this effort.”

Individual Insurance Marketplaces

The letter urges the president to save individual insurance markets in states. To accomplish this, the group says insurance purchased through current ACA marketplaces should be continued through 2019.

In addition, the group says, any changes to offered plans on the exchanges in future years should be done with sufficient notice and financial assistance to encourage individuals to maintain their coverage, even in the absence of an individual insurance mandate.

The group also urges the president to allow states that have functioning exchange marketplaces to maintain them. At the same time, the group says, states that haven’t set up their own marketplaces should be encouraged to do so “in concert with reforms in the insurance markets to ensure that choice in plans will be available.”

The group also advocates creation of high-risk pools that could provide affordable coverage to individuals with certain chronic diseases.

Medicaid Reform

In its letter, the group also urged the administration not to pull back on Medicaid expansion. The letter says states that decided to expand Medicaid coverage under the law should “continue to receive the promised levels of federal support in accordance with the current terms of the ACA.”

Additionally, the group says, any efforts to reform the Medicaid payment system, such as a move to block grants, shouldn’t penalize states that have expanded their Medicaid coverage by imposing per capita limits on funding.

The group’s proposal also says any reduction to hospital reimbursement as a result of Medicaid reform could be offset by restoring Medicare funding cuts imposed by the ACA.

In addition to those recommendations, the group urged attention to the Medicare Shared Savings Program and asked that any taxes included in the ACA be repealed only in conjunction with broader tax reform as a way of making sure any held-over programs can remain funded.

To contact the reporter on this story: Matthew Loughran in Washington at

To contact the editor responsible for this story: Peyton M. Sturges at

For More Information

The letter is at

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