A growing number of lawmakers on Capitol Hill, many of them doctors, are moving to scratch language from the Affordable Care Act that gives federal regulators the power to define what constitutes "quality" healthcare.
A group of four Senate physicians offered companion legislation on May 2 to the House's SCOPE Act (Safeguarding Care of Patients Everywhere), seeking to repeal Section 1311 of the Obamacare law that includes a 23-word passage allowing the Health and Human Services secretary to define what "quality healthcare measures" means for healthcare providers.
"A political appointee now has full discretion to determine what constitutes 'quality' care, despite what is actually best for an individual patient," said Sen. Tom Coburn, R-Okla., who was joined by three other physician senators — John Barrasso, R-Wyo., John Boozman, R-Ark., and Rand Paul, R-Ky. — to introduce S. 2278, which seeks repeal
of that portion of the law.
"Allowing an unelected bureaucrat to have unilateral power to interfere with the physician-patient relationship is unprecedented," Coburn said.
The Senate bill follows on the heels of legislation reintroduced by Republican Rep. Phil Gingrey, a Georgia obstetrician who first introduced such a measure — HR 6320 — in 2011. Gingrey, whose bill has 17 co-sponsors in the House, said the government has no place in the middle of patients' healthcare decisions.
"It violates the sanctity of the doctor-patient relationship, as physicians are trained to treat patients individually and not with a 'one-size-fits-all' approach," Gingrey said. "Someone who isn't bound by the Hippocratic Oath, isn't required to have medical expertise, and isn't held accountable by medical societies has no business diagnosing patients. The SCOPE Act keeps medical decisions where they belong — in the hands of patients and their physicians, not the federal government."
Gingrey added: The act "repeals this regulation, protecting patients' access to their medical providers and ensuring physicians may continue treating individuals as they deem necessary. The SCOPE Act continues to hold physicians accountable to their state licensing boards, insurance companies, and professional groups, without intrusion by federal bureaucrats."
Edmund F. Haislmaier, a senior research fellow in health policy studies at the Heritage Foundation in Washington, said the provision that the lawmakers are seeking to repeal is "a bad idea."
"It's giving the secretary a very undefined grant of authority to set these standards and impose them on plans in the exchanges," Haislmaier told Newsmax. "It's just one more thing that will encourage more doctors to say, 'The heck with it, I'm out of here.'"
In spite of some warnings, Haislmaier said the Obamacare measure won't suddenly shut down someone's medical practice. But hospitals will be stuck with complying with the provision, he said. "They are dependent on government-insured patients for much of their revenue. The physicians who are dependent on hospitals are stuck."
The measure's directive stands in stark contrast to how conservatives view the best way to reform the healthcare system. "The conservative issue is it's a bottom-up consumer-driven market. Let the doctors and patients decide what is best and work it out in the market," he said.
By contrast, he said, opponents of that strategy believe "they know best, and they will now use this as a regulatory tool."
Twila Brase, a public health nurse who serves as president and co-founder of the Citizens' Council for Health Freedom, said she fears such vague language, backed with bureaucratic power, could lead physicians to be blacklisted in the future.
Brase pointed out that the words in the brief passage under a section titled "Quality Improvement" could be mean doctors would be sent packing by an arbitrary review of the federal government.
"Beginning on Jan. 1, 2015, a qualified health plan may contract with … a healthcare provider only if such provider implements such mechanisms to improve healthcare quality as the [Health and Human Services] secretary may by regulation require," she said, citing the law's language.
Brase, in a column on her group's website
, said the word "mechanisms" could mean several things.
"Required 'mechanisms to improve healthcare quality' could include requirements to comply with government-issued treatment protocols, use the cheapest treatments and the oldest medications, use global budgets to ration care, limit care for elderly and disabled, and weigh the individual patient's needs against the needs of government-defined 'populations,'" Brase wrote.
"These mechanisms could include data reporting requirements, using a computerized medical record accessible to the government, collecting race, ethnic, gender, and sexual orientation data, or implementing the intrusive ICD-10 diagnosis treatment coding system, which will document in code a detailed profile of each patient's health. The 'mechanisms' will likely have nothing to do with actual quality of care."
Brase told Newsmax that her organization has tried to convey that the new law will likely impact patient relations with doctors. She said too few people have paid attention to provisions within the lengthy legislation, including healthcare providers and prospective patients.
"I don't think people understand or even know about this provision, which says if the doctors are not practicing the way the government wants them to practice, they can be blacklisted from every plan that is part of an exchange," she said.
"Essentially, it will shut them down," Brase said. "I actually think a lot of doctors don't know this exists. It puts extraordinary control in the hands of a single bureaucrat to control the physician" concerning "anything that the HHS secretary thinks has to do with quality, and quality is not defined."
She added: "This is broad-sweeping control over the practice of medicine. In 2,700 pages of this law, these are 23 words packed with governmental power."