Affordable Health Care Act Passes House

Posted by The Arc of North Carolina
Yesterday the House passed the American Health Care Act (AHCA, H.R. 1628) a bill to repeal the Affordable Care Act and dismantle the Medicaid program as we know it by only four votes (217-213).  
 
What happens next?
H.R. 1628 will head to the Senate where it will likely have a steep hill to climb.  It’s unclear if the Senate will be able to pass the bill as is with a simple majority (51 votes) under what’s known as reconciliation instructions, or a 60-vote majority which would require bipartisan support.  Any change to the bill would have to go back to the House for another vote or through a conference committee between both the House and Senate.  What does that mean? The Affordable Care Act and current Medicaid funding will remain the law of the land until both the House and Senate vote to pass identical bills.  
 
That gives us a window to educate lawmakers, make calls, request meetings with elected officials, and protect the programs that keep our community healthy and living with dignity in the community.  You are the key to that advocacy.
 
What are some of the key AHCA provisions the Senate will be reviewing?
  1. Medicaid: this bill would sever the current Federal/State relationship
    Instead the current partnership where NC pays 0.33 cents and the federal government pays 0.67 cents of every dollar spent for qualifying individuals (including optional waiver services and supports), Medicaid would be converted to either a block grant or a certain amount per enrollee.  This would cut state Medicaid budgets by up to 30% over 10 years, and states would have to either raise revenue or cut services and eligibility to reduce costs.  Once our current federal/state partnership is undone, there is nothing that would prevent further funding cuts in later budgets.

  2. Key protections become options for states   
    Under the AHCA, states could opt out of the most essential coverage protections for enrollees, many key to individuals with disabilities. States could:
    -Opt out of Essential Health Benefits, including habilitation services, mental health services, maternity care and prescription drugs among others  
    -Deny coverage or charge more for preexisting conditions
    -Bring back annual or lifetime caps to reduce insurance costs (employer-based coverage)
    -Charge older individuals more than 5 times more than younger enrollees

    If states chose to opt out of key provisions, they would be required to create alternate ways to ensure people with expensive health care needs could get coverage.  The law would provide $138 billion over 10 years to help those states recreate high risk pools (extraordinarily expensive insurance products for people who have – or a history or – expensive or complex health needs.

  3. Changes in the individual mandate (requirement to have insurance)
    While the AHCA would no longer require an individual to have insurance, an insurance company could charge someone with pre-existing conditions 30% more over 1 year if they had a lapse in coverage.  A lapse in coverage is defined as more than 63 days without coverage.

  4. Income based tax credits and subsidies to help low income individuals to buy insurance would be replaced with tax credits based on age and income. The Kaiser Family Foundation has created an interactive map to show what those changes might mean across the country.

  5. Nearly all taxes used to pay for subsidies to make insurance more affordable would be eliminated.  

  6. A roll back of Medicaid expansion as well as increased federal funding match for certain initiatives in those states that participated (not applicable to North Carolina)
 
Net effect if these changes were put in place:
  • -Increased variability in insurance policies, some with fewer benefits and protections and/or lower premiums.
  • -A shift in financial risk to states, hospitals, and ultimately people: larger uninsured populations, less Medicaid dollars, greater unmet health needs and reliance on crisis-based services
  • -Community based waiver services would be at significant risk: decreased service array, service amounts, and eligibility would be likely cost-saving measures
 
  ** The Congressional Budget Office has not scored the bill passed by the House, meaning that it was voted on and passed before an independent analysis of who would be affected or what it would cost has been completed.
 
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