SCOTT SIMON, HOST:
It's President Trump's 100th day in office. He's still working on a day one promise - to repeal and replace the Affordable Care Act that was the hallmark of the Obama administration. President Trump and House Speaker Paul Ryan renewed their push this week. They hope to bridge the divide between hard-line conservatives and moderates in the House Republican caucus. One group that remains unconvinced is the American Medical Association. Dr. Andrew Gurman is the AMA's president, and he joins us now from Omaha, where he's traveling. Dr. Gurman, thanks so much for being with us.
ANDREW GURMAN: My pleasure. Thank you for having me.
SIMON: What makes you uncomfortable about the language so far that is being circulated on Capitol Hill that's being proposed?
GURMAN: Well, we had a number of problems with the original bill, the AHCA, and we think that this proposed amendment just makes it worse.
SIMON: How so?
GURMAN: Well, what it does is it does away with the prohibition against rating on pre-existing conditions, meaning that if you have a pre-existing condition - and about a third of us do - that you could be charged a much higher rate for insurance. So let me give you an example. Somebody is working, they have insurance, and they have a catastrophic illness - cancer, some other calamity. They have to stop working because they need to get their condition taken care of. If they're out for 60 days, they lose their insurance. And now, they have to pay whatever the insurance company decides is the premium because they are - now have a pre-existing condition. Somebody in that situation may never be able to accumulate enough money to pay the very high premiums and get back on the cycle of having continuous insurance coverage.
SIMON: Now, of course, Speaker Ryan looks forward to what are called now high-risk pools. These would be plans that are essentially devoted to try and accommodate people who have expensive and pre-existing conditions. You're not convinced that would do it.
GURMAN: Well, I think that the problem with those is in the fine print. First of all, very often they are not adequately funded. And many of the high-risk pools have lifetime caps, lifetime limits.
SIMON: What kind of reforms would you like to make?
GURMAN: Well, we think that the individual insurance markets need to be stabilized. There needs to be certainty. Right now, the insurance companies are putting together their plans for rating the 2018 insurance products, and they have no certainty from Congress regarding the support for insurance premiums for lower income people. Without knowing those, they don't know how to price their policies, and they're going to price them very high. So the bit - that's the biggest thing that needs to be addressed right now.
SIMON: Dr. Gurman, I move to ask you a question, both as a physician with a practice and the head of the AMA, how much time do you have to spend on matters that have nothing to do with medicine?
GURMAN: Well, unfortunately, a lot. We know from doing detailed studies where we actually follow doctors and minute to minute with a stopwatch find out what they're doing. The doctors are spending less than half of their time actually taking care of patients. So it's a big problem.
SIMON: And how would you reduce that bureaucracy, though? Because, you know, bureaucracies run on (laughter) run on a paper trail in a sense.
GURMAN: Well, yeah, I think that we have to work on the electronic health records, make some of these reporting requirements and some of the documentation requirements more seamless, things that will fit into the normal workflow of a physician practice. You know, medicine is one of the only industries where technology has not led to efficiencies and improvements. Technology has simply been a tremendous burden for a lot of practices.
SIMON: Yeah. Do I get what amounts to the bottom line of your advice correctly in that in the absence of a better idea, you and the AMA would be comfortable sticking with the Affordable Care Act?
GURMAN: There are lots of things in the Affordable Care Act that need to be improved, but we would be comfortable improving them rather than throwing the whole thing out, particularly since we have no indication of what it would be replaced with.
SIMON: Dr. Andrew Gurman is president of the American Medical Association. Doctor, thanks so much for being with us.
GURMAN: It's an honor to talk to you. Thank you so much. Transcript provided by NPR, Copyright NPR.