Today’s Congressional Budget Office (CBO) report confirms what we already suspected: despite last minute changes made prior to a misguided and party-line House vote, the American Health Care Act (AHCA) seriously threatens health coverage affordability, access, and care delivery, and would cause roughly 14 million individuals to lose coverage by 2018, and 23 million to lose coverage by 2026.
The American Nurses Association (ANA) remains opposed to the AHCA and urges the Senate to abandon the bill advanced by the House in favor of a more transparent process that truly aims to expand access to affordable quality care.
According to the report, the AHCA would allow for various waivers that would undermine protections for those with pre-existing conditions, and undercut access to essential health benefits for roughly one-sixth of the population. Taken together, these waivers would cause premiums to “vary significantly according to health status and the types of benefits provided, and less healthy people would face extremely high premiums,” according to the CBO. “Over time, it would become more difficult for less healthy people (including people with pre-existing medical conditions) in [states that make use of the waivers] to purchase insurance because their premiums would continue to increase rapidly.”
The bill also continues to pose a serious threat to those Americans who rely on Medicaid, a majority of whom are children. Rolling back state expansion of Medicaid would effectively cut off coverage for millions of low-income Americans and further upend the health care landscape.
Though today’s score was marginally better than the first assessment released in March, the negative consequences for those who need care most remain extreme. In particular, the CBO noted that “out-of-pocket spending on maternity care and mental health and substance abuse services could increase by thousands of dollars in a given year for” those not covered by group health insurance plans.
The ANA encourages the Senate to draft a comprehensive health care plan that protects Americans from being denied insurance coverage because of pre-existing conditions and provides access to affordable health insurance coverage plans that offer a minimum standard of benefits. These include preventative services and screenings, inpatient and outpatient services, prescription drug coverage, mental health, maternity services, and chronic disease management.
As I covered previously, the U.S. House of Representatives on May 4, 2017, recklessly passed the American Health Care Act by a 217-213 vote. They did so with little transparency, thoughtful debate, or meaningful stakeholder input. Crucially, they also passed this bill without even knowing its potential impacts on the ability of Americans to access quality health care services. Based on an analysis of the previous version of the American Health Care Act, however, this bill would likely result in the loss of health care coverage for 24 million Americans, potential restrictions for 15 million Americans with pre-existing conditions, and $800 billion+ in Medicaid funding slashed over ten years.
According to a report released on May 18 by Avalere Health, children would be significantly impacted by the proposed Medicaid changes in the American Health Care Act. Funding for children on Medicaid would be slashed by up to $43 billion over ten years under a per capita cap plan, while it would be slashed by up to$78 billion under a block grant plan (read more about block grants here). While Medicaid is often discussed in terms of an entitlement and with a particular focus on the controversial Medicaid expansion, its impact on children’s health care does not receive nearly as much attention. Children represent the largest group of enrollees covered by Medicaid, and the program covers nearly half of all births in the United States. Medicaid provides crucial health care services to children and, under Early and Periodic, Screening, Diagnostic, and Treatment (EPSDT) requirements, these children cannot be denied necessary care. This health care (or lack of) impacts the health of the child for the rest of his or her life; a healthy child is more likely to grow into a healthy adult.
As we wait for the American Health Care Act to move to the U.S. Senate for consideration, the American Nurses Association encourages all 100 senators to consider the stakes of this bill for the health of our nation’s children. Access to quality health care for children not only ensures that they are healthy in the here and now, but also ensures that we are raising a healthy and productive generation of Americans who are able to lead productive lives to the best of their abilities. ANA also urges the Senate to reject the flawed American Health Care Act – which flies in the face of our stated health care reform principles – and to undertake a deliberative, thoughtful, and transparent process which produces a piece of legislation which ensures quality health care access to all Americans.
Last week, Michele Woodward, a prominent Republican and former White House staffer in the Reagan Administration, posted a powerful critique of the Republican health care reform bill known as the American Health Care Act. Ms. Woodward noted of the legislation that:
You see, the health care bill passed in the House today has nothing to do with making sure all Americans have access to healthcare. The GOP leadership didn’t go in saying, “How can we raise the standard of living for all Americans by insuring their health?” No, they did not. Instead, they said, “How much money can we take out of this program?” Why? Because taking money from Obamacare allows the tax cuts the GOP really wants. Tax cuts that mostly benefit the wealthy and large corporations. Tax cuts that will continue to ensure that we don’t spend enough on critical infrastructure. They are single-minded in their pursuit of starving the government of funds and, thereby, fundamentally changing the American way of life for the worse.
The American Nurses Association takes similar issue with this piece of legislation. First and foremost, the American Health Care Act would deny millions of Americans access to critical health care services. Although the Republicans in the House decided to blindly vote on this bill without knowing its financial or human impact, it is not substantially different from the previous version of the bill which would have resulted in a loss of health care coverage for 24 million Americans and an $880 billion reduction in Medicaid funding. This version, in fact, would also put at risk the ability of the roughly 15 million Americans with pre-existing conditions to purchase and access critical health care services. The process by which the legislation moved through the House was also striking for its lack of transparency and the absence of meaningful debate, stakeholder input, or bipartisan collaboration. The House, in short, was reckless in its determination to pass this flawed legislation.
Further, this legislation marginalizes vulnerable populations by eroding their ability to access health care services for the benefit of the wealthiest Americans, who would receive a large tax cut. Such a shift goes against ANA’s core principles of health care reform and, as Ms. Woodward pointed out, would fundamentally change the American way of life for the worse. The American Nurses Association stands in opposition to this bill and urges the Senate to take a far more judicious and bipartisan approach to health care reform which ensures that all Americans – rich and poor, young and old, sick and healthy alike – have access to comprehensive health care services.