Let’s Be Clear - America’s New “Health Care” Act

House Republicans recently unveiled their version of “health care for all” in the form of the American Health Care Act – the repeal and replacement of the Affordable Care Act which enabled over 20 million Americans to access health care coverage. Budget reconciliation bills were introduced in the Ways and Means and Energy and Commerce committees and are collectively titled the American Health Care Act. With no hearings and no budget estimate from the nonpartisan Congressional Budget Office, the House Republicans hope to move the bill to the full house by early April without addressing how much the bill will cost and how Americans who are currently covered will be impacted.

While this replacement bill retains a number of the ACA provisions, e.g., prohibiting denial of coverage due to a pre-existing condition, and no lifetime or annual limits on coverage, many of the proposed provisions will make health coverage more expensive or deny coverage completely for those covered under Medicaid. The new proposal allows insurance companies to charge as much as five times more for premiums to older adults, and eliminates tax penalties for companies and those who refuse to purchase health insurance (the individual mandate under ACA) but allows insurance companies to charge a 30% surcharge on premiums for those who let their insurance lapse if and when they decide to purchase coverage. The 30% “premium penalty” – while not a “tax” per se – only enriches the insurance companies. And with no incentive for younger, healthier people to buy health insurance, the ability of insurance companies to spread the risk is limited and that will lead to higher premiums and denial of coverage particularly for older adults. 

Medicaid expansion enrollments will end in 2019, with those who left the expansion program in the interim for any reason unable to return. The proposal replaces federal financial participation (California, for example, is a 50-50 state, whereby 50% of funding for certain categories of Medi-Cal beneficiaries is from the federal government) with a per capita allotment, severely reducing federal funding which leads to a reduction in the states’ Medicaid budgets which leads to a reduction in the number of eligible Medi-Cal beneficiaries and a reduction in payments to providers. As Justice in Aging recently noted: “Over 6 million older adults rely on Medicaid, and 2/3 of all Medicaid spending for older adults goes to essential long term care services in nursing homes and at home and in the community. AHCA threatens the care of all of these seniors and the peace of mind of their families.”

Let’s be clear:  this proposed “health care” bill is not about patient access or protections at all. It’s about denying coverage to millions of Americans to pay for tax cuts to the wealthy and lining the pockets of the insurance companies – crafted by congressional representatives who are guaranteed comprehensive health care for life at taxpayers’ expense.