The House of Representatives voted last week to kill many provisions of the ACA and replace them with the Affordable Health Care Act (AHCA), a bill that would deny millions of Americans, including older adults and people with disabilities, good affordable health insurance. The bill passed by a vote of 217-213, without an estimate of its costs or an understanding from the Congressional Budget Office (CBO) of the full range of projected consequences for people with health insurance today, including people with Medicare and Medicaid.
But, as Tim Jost reports in Health Affairs, the AHCA provisions entail substantial cuts in health care spending, deprive low-income Americans of Medicaid coverage and leave tens of millions of Americans–those with employer coverage and those with individual coverage–uninsured or underinsured. Based on earlier projections, because it eliminates the Medicare tax on wealthy Americans, if passed, AHCA would also shorten the life of the Medicare Trust Fund by two years.
In brief, AHCA, the Republicans’ proposed health care law would:
- Hand hundreds of billions of dollars in tax cuts to pharmaceutical companies, medical device companies, along with the wealthiest Americans. In the process, it would weaken Medicare, and it would jeopardize the financial base that supports health care subsidies for people with low incomes in the state health insurance exchanges. Some good news: It keeps the provision in the ACA that closes the Medicare prescription drug donut hole in 2o2o.
- Allow insurers to charge older people five times more than younger people and even more than that if states permit it. Inevitably, this would mean that older people not yet eligible for Medicare and without employer coverage would be hard-pressed to afford health insurance.
- Slashes Medicaid funding by $880 billion over the next 10 years. It also imposes either state block grants that may keep eligible individuals from getting coverage or per person payment caps that could limit Medicaid benefits. The 11 million people with Medicare and Medicaid might no longer be able to rely on Medicaid to help cover their Medicare premiums, coinsurance and deductibles, or their nursing home care.
- Mean 24 million people will lose health insurance coverage. It would not be affordable for them.
- Allow employers and states to offer policies that leave people without essential benefits and underinsured; moreover, if insurers are able to offer policies that do not cover key benefits, people will no longer be protected by the ACA’s cap on out-of-pocket costs for those benefits. They also will no longer be protected by the ACA’s protection against lifetime coverage limits for those benefits.
- Keep tens of millions of people with pre-existing conditions from getting affordable coverage in states that permit insurers to raise rates on these people. And, even if people with pre-existing conditions could afford health coverage, it’s not clear that the coverage available would offer the health care benefits they would need.
- Cut health insurance subsidies based on income for people in the health exchanges beginning in 2020 and replace them with a small tax credit based on age to people with low incomes.
- No longer impose tax penalties on individuals who do not get coverage or employers who do not offer coverage. This would likely mean that younger healthier individuals would not buy coverage, driving up premiums by 15-20 percent for everyone else. And, many employers will stop offering health insurance coverage.
- Lead to 1.8 million people losing their jobs.
Of note, House Republicans, knowing full well the implications of these provisions, ensured that they and their staff continued to get good affordable coverage. The American Health Care Act protects members of Congress and their staff from some of its harshest provisions. Among other things, they are guaranteed coverage of all essential benefits even if their states opt to cut them for everyone else. Similarly, their insurers cannot charge them more if they have pre-existing conditions, even if their states waive this protection for everyone else.
Not surprisingly, hospitals and doctors are expressing concern with this bill. It will likely leave hospitals and doctors holding the bag for the cost of care for millions of Americans, including people who opt not to get coverage and need costly health care and people who are forced to buy inadequate coverage. Given, Medicaid cuts, insurers are likely to lose a big block of Medicaid business. But, if the bill becomes law, they are also likely to be given the freedom to cut benefits and charge exorbitant premiums to people with pre-existing conditions in many states, which will be helpful to their bottom lines.
AHCA is now in the hands of the Republican-controlled Senate. In order to pass, every Senate Republican but two must support it.
Here’s more from Just Care: