The American Health Care Act
The Affordable Care Act (ACA) was unpopular before the ink of President Obama’s signature was done drying. There have been numerous votes in Congress to repeal the ACA entirely, limit the reach of the law, or delay its implementation. It was not until the 2016 election, when Republicans gained control of the White House, Senate, and House, that the effort to repeal or scale back Obamacare became possible.
Using an obscure Senate procedure known as “reconciliation,” Republicans are moving forward with the first phase of repealing the law, without the normal 60 votes needed to pass legislation in the Senate. Reconciliation rules require that the legislation have a budgetary impact (for example, by defunding the individual mandate or changing subsidies for premiums to tax credits). In return, lawmakers are able to limit debate on the bill to 20 hours, in addition to bypassing the filibuster.
The American Health Care Act (AHCA) was introduced in Congress on March 6, 2017. The AHCA does not repeal the ACA. Instead, it repeals parts of the law and keeps others (see below for provisions of the bill). After the AHCA was introduced, the Congressional Budget Office (CBO) estimated it will cover 24 million fewer people than the ACA did. 14 million will be uninsured in the first year, and by 2026, 52 million Americans will be uninsured. Utahns who could lose their coverage include: 197,187 Utahns covered by ACA marketplace insurance, 400,000 Utahns who will see drastic cuts to Medicaid and benefits, 167,000 Uthans who receive premiums subsidies, and 142,000 Utahns who depend on the ACA’s cost-sharing reductions to limit their doctor office co-pays and annual deductible. To see more on how the AHCA would affect Utah, visit the Utah Health Policy Project website here.
In the first weeks after it was introduced, the AHCA has seen a lot of opposition from both Democrats and Republicans. The new health care bill has been jokingly referred to as “Obamacare lite.” The report from the CBO has made the AHCA even harder to defend. Disgruntled by the news from the CBO, many Republicans on Capitol Hill began to attack the nonpartisan office. Although this bill is under severe scrutiny and criticism, President Trump lauded the bill both before and after the CBO report was released.
In an attempt to appease the more conservative members of Congress who are opposed to the AHCA because they feel it does not do enough to repeal Obamacare, House leaders introduced an amendment to the bill. There is still opposition to the AHCA even with these changes, notably coming from conservative groups such as the Heritage Foundation and the Congressional Freedom Caucus. Click here to see the changes made by the amendment.
Changes to Health Insurance Plans
- Ends the subsidies the ACA provided for low- and middle-income individuals to purchase health insurance, replacing them with tax credits based on age. Those under 30 would get $2,000 a year and that would increase based on age up to where those over 60 would receive $4,000 per year. Individuals earning under $75,000 and families earning under $150,000 would receive the full amount of the tax credit. A recent amendment has created a fund to help with tax credits for seniors; however, it is still unclear how this money will be used.
- Repeals the individual and employer mandates. To encourage individuals to purchase health insurance, the AHCA includes a “continuous coverage” provision imposing a 30% premium surcharge for those who go without insurance for two months.
- Allows insurers to charge older citizens five times more than a younger citizen.
- Repeals $1 trillion in taxes over the next ten years on high-income earners, drug-makers, insurers, medical device makers, and executive salaries.
- Makes it easier and allows for larger savings into Health Savings Accounts.
- Cuts funding to Planned Parenthood and other organizations that offer abortion services.
- Repeals provision mandating that insurers protect the “10 Essential Health Benefits.” To learn more, click here.
- The AHCA does keep the exchanges created under Obamacare, continues to protect pre-existing conditions, and allows parents to keep children on their plans until they turn 26.
Changes to the Medicaid Program
- Reduces the amount of money going into the program by $880 million over the next 10 years – leading to coverage and benefit cuts in a program that provides coverage to over 320,000 individuals and working families in Utah — including more than 198,000 children, almost 16,000 seniors, and over 34,000 persons with disabilities.
- Repeals Medicaid expansion after 2020. Those who have received coverage through Medicaid up until that point can remain on the program as long as they qualify.
- Does away with the current mechanism through which Medicaid pays for all services. Instead, states would be given flexibility on how they use money, with the money being given through either per capita grants or block grants.
- Allows states to include a work requirement in their Medicaid programs, with states receiving extra federal funding for administrative costs if it is included.
Disability advocate Barbara Toomer, who has long fought for people with disabilities to live in their communities in the least restrictive environment, said the American Health Care Act, as proposed, would have far-reaching effects.
The focus of “repeal and replace” remains in the House, where representatives are expected to vote on the AHCA Thursday. However, the bill’s real test lies in the Senate where Senator Mike Lee and others still plan to vote “no,” making it difficult for Senate Republican leaders to gather the votes they need to pass the law before April recess.
Republicans Introduce Amendment to "Sweeten" AHCA
In order to get more Republicans to vote “yes” on the precarious AHCA, House leaders have introduced an amendment that would give an additional $85 billion for tax credits to help Americans between 50 and 64 years old. The amendment also allows states to include a work requirement in their Medicaid plans, as well as giving states the option to convert Medicaid funding to block grants.
Despite repeated Trump overtures, Sen. Mike Lee remains a no on health care bill
After having met with White House officials twice over the past week to discuss the American Health Care Act, Senator Mike Lee (R-Utah) stated that he still plans to vote “no” on the bill. Senator Lee is looking for a more robust repeal of the ACA, blaming the regulations implementing Obamacare on the rising costs in premiums.
If the terminology of Republican Medicaid policy—“per-capita caps,” “block grants,” “inflation targets”—seems a bit arcane, Monday’s release of the Congressional Budget Office’s report on the GOP’s repeal-and-replace bill makes it pretty simple: The current health-care proposal is about rationing care to fund tax cuts for the U.S.’s highest earners.
New York Times Highlights Obamacare Growth in Utah
Noting that Utah had one of the highest Obamacare enrollment growths in the nation despite its Republican leanings, the New York Times came and profiled several individuals in the state who rely on the Affordable Care Act for their health insurance.
Everything you need to know about the new GOP health care bill
PBS NewsHour breaks down the American Health Care Act, taking a look at what the bill repeals, keeps, or adds to the Affordable Care Act.
This map shows what is at stake for Americans as Republicans gear up to vote on their health reform proposal, or Trumpcare, by state and congressional district. Trumpcare would cause Americans to pay thousands of dollars more per year for their coverage while taking away health insurance from millions.
This graphic from the Utah Health Policy Project shows how Utah families will be hurt by the AHCA and lists the number of Utahns that are at risk of losing coverage.
The New York Times is tracking how House Republicans are planning to vote on the AHCA. Rep. Chris Stewart (UT-2) and Rep. Mia Love (UT-4) have indicated that they will vote “yes” on the bill. The votes of Rep. Rob Bishop (UT-1) and Rep. Jason Chaffetz (UT-3) are unclear or undecided.