On March 6, House Republicans introduced the American Health Care Act (“AHCA”), legislation that would repeal and replace the Affordable Care Act. We are following the various repeal/replace efforts and want to provide information that will enable you to be well-informed on the issues.
Equitas Health opposes the AHCA as drafted because it will cause people to lose insurance coverage due to higher costs, restrict Medicaid expansion, and remove the entitlement to Medicaid.
The AHCA includes the following provisions that will impact many people we serve, including LGBTQ people, people living with HIV and AIDS, and people at risk for contracting HIV:
- Modifies premium tax credits for 2018-2019. Instead of making tax credits available based on financial need, tax credit amounts will be based on age, with older people getting twice as much ($4,000 per year) as younger people ($2,000). By 2020, a family of four making roughly $60,000 a year will see their cost of coverage increase by $9,024. Higher premiums and cost sharing will force individuals with ongoing health needs to make difficult decisions about accessing care.
- Effectively renders useless the mandate that nearly all Americans must have health insurance by reducing to $0 the tax penalties for not having insurance. The individual mandate, which required people to pay a penalty if they didn’t have health coverage, was a mechanism to encourage healthy people to buy coverage to help improve insurers’ risk pools, since the pools also include individuals no longer barred from coverage for having a preexisting condition. Higher risk pools mean higher cost health care in the form of increased premiums. Although the bill retains the prohibition on discriminatory premiums and pre-existing condition exclusions, individuals living with pre-existing conditions will pay more in premiums and out-of-pocket costs for the comprehensive coverage they need to manage their conditions.
- Reduces federal funding for Medicaid and eliminates the program’s entitlement status. Starting in 2020, the plan would reduce federal funding for the ACA’s Medicaid expansion to all low-income individuals under 138 percent of the poverty level. This will effectively shift a significant portion of the cost of the Medicaid expansion population to the states instead of the federal government, which will no doubt result in states questioning their ability to continue to serve these individuals. In 2020, states would no longer be allowed to enroll anyone under the expansion criteria.Additionally, an enrollee who loses eligibility for the expansion program could not re-enroll. Perhaps most importantly, the plan removes the entitlement to Medicaid and caps federal funding on a per person basis. This will shift costs to the states, forcing states with already constrained budgets to limit eligibility, reduce benefits, and/or increase premiums or impose cost sharing. Nearly 30 percent of consumers covered under Medicaid expansion have a mental health or substance use disorder. Without Medicaid expansion, these consumers will be without access to critical services.
- Establishes a Patient and State Stability Fund beginning in 2018. States could use funding from this program for a variety of initiatives, such as building high-risk pools to cover people with costly medical conditions, establishing programs to subsidize providers for direct provision of care or to reduce cost sharing, creating programs to promote access to preventive services,or many other initiatives. The federal government proposes investing $100 billion over 10 years to fund this proposal. While it might appear as though this fund is intended to support positive developments, the reason for its very existence – to help states pay for costs of providing health insurance that will be shifted to them from the federal government as a result of many of the initiatives mentioned above – cannot be overstated. Additionally, states can use the money to establish high-risk pools, which are widely regarded to drive up the cost of health care for individuals with chronic diseases, including HIV and AIDS.
What You Can Do
Additionally, we encourage our partners and advocates to contact the following committees and members to voice your opposition to the American Health Care Act.
- The House Ways and Means Committee and House Energy: Call (202) 225-3625.
- House Energy and Commerce Committee: Call (202) 225-2927.
- Representative Pat Tiberi” Call (614) 523-2555 (Central Ohio office) or (202) 225-5355 (Washington office).
- Representative Robert Latta: Call 800-541-6446 (Ohio) or (202) 225-6405 (Washington office).
- Representative Bill Johnson can be reached at (855) 376-0868 (Ohio) or 202-225-5705 (Washington office).