Wednesday, May 3, 2017— Today, Representatives Fred Upton of Michigan and Billy Long of Missouri struck a deal to win back moderate Republicans that committed to voting against the House Republican bill to repeal and replace the Affordable Care Act. But fresh analyses from national consumer advocacy groups, like the Center on Budget and Policy Priorities, reveal the House bill still eviscerates critical protections for people with pre-existing conditions and fundamentally changes the Medicaid program. A vote could come as soon as tomorrow (Thursday) afternoon. This remains an incredibly crucial time for advocacy.
As PHLP reported in our April Health Law PA News, the House of Representatives revived its proposed legislation to repeal and replace the Affordable Care Act. After not having enough support to bring the legislation to the floor for a vote in March, House leadership and the Trump Administration have been engaged in negotiations with Republican members of the Freedom Caucus and the more moderate Republican members of the Tuesday Group. The deal struck (known as the MacArthur Amendment) allows states to opt out of several Affordable Care Act mandates: the requirements related to covering Essential Health Benefits, and the protections for consumers with pre-existing conditions that prevents them from having to pay more for coverage based on their health conditions.
The House’s bill appears to move people with pre-existing conditions to high risk health insurance pools. Congressional leaders are reportedly considering adding $8 billion to the $130 billion the bill already included for grants to states for these pools. But some experts have concluded $138 billion for high-risk pools is not enough. It would leave these pools underfunded by at least $200 billion (other experts have arrived at much higher estimates).
Moreover, high-risk pools have more fundamental flaws. Where the ACA made it possible for people with pre-existing conditions to get the same kinds of insurance as everyone else, the amended House bill would segregate them in high-risk pools that pool sick people with even sicker people. Historically, that led to coverage with very high premiums, benefit exclusions, annual and lifetime limits, and other problems – even when pools were sufficiently funded to avoid waiting lists. Pennsylvania’s previous experience with the adultBasic and PA Fair Care bears this out. Those high risk pools, which partially subsidized insurance premiums for people often in need of costly medical care, turned out to be more expensive than Pennsylvania officials, consumers, and private insurers expected.
Equally important, the drastic changes to Medicaid included in the original AHCA legislation remain:
- Effectively ending Medicaid expansion. Under the House bill, the federal government would no longer provide enhanced funding for new Medicaid enrollees after 2019 (including for 700,000 low-income Pennsylvanians), forcing most or all of the 31 states and Washington D.C. that have adopted the ACA’s Medicaid expansion to drop it.
- Threatening Medicaid home- and community-based services for people with disabilities. The House bill drastically changes the way the federal government finances the Medicaid program by capping and cutting federal funding for virtually the entire Medicaid program, setting annual limits on federal funding per-enrollee that would grow more slowly than the need for that funding would rise, and forcing states to make deeper cuts in their Medicaid programs with each passing year. The Robert Wood Johnson Foundation estimated that this aspect of the AHCA would slash $880 billion dollars from Medicaid across all states (and cut Pennsylvania’s Medicaid program by $162 billion). Faced with these large cuts in federal Medicaid funding, Pennsylvania would have to cut home- and community-based services, an optional Medicaid benefit that most states already limit based on available funds. These services, which include nursing and home health care and help with chores, meals, transportation, and other services, let people with serious health problems remain in their homes instead of having to be placed in a nursing home.
The vote counts are close—so close that Pennsylvania’s representatives can literally make the difference! The hopeful news is that several Pennsylvania Republican Congressmen continue to express grave reservations about the House bill. It will be up to them to stop a bill that jeopardizes the health care of millions of Pennsylvanians. This is the time to express your concerns about the ACHA and about Medicaid and its future funding.