On May 4, 2017, the U. S. House of Representatives passed H. R. 1628, the American Health Care Act (AHCA), by a vote of 217 to 213
By PVA National Staff
On May 4, 2017, the U. S. House of Representatives passed H. R. 1628, the American Health Care Act (AHCA), by a vote of 217 to 213. The bill would significantly modify the Patient Protection and Affordable Care Act (ACA), also known as Obamacare. Twenty Republicans joined all of the Democrats in the House in voting against the measure. The bill is not a complete repeal of the ACA, as has been promised by Republicans for seven years, but deals only with those parts of the ACA with budgetary implications in order for the Senate to pass it with a simple majority vote, a process none as reconciliation.
The AHCA reduces funding for subsidies provided under the ACA to make health insurance coverage purchased through the health exchanges more affordable and tilts the benefits of those subsidies toward younger people. However, it also creates tax credits that would be available to people to purchase health plans outside the exchanges. The measure eliminates a number of taxes, including those on health insurers, under the ACA that were designed to pay for its provisions. Instead of a mandate that individuals carry health insurance, H.R. 1628 would allow insurers to charge those with coverage gaps longer than 63 days a one-year, 30 percent surcharge on their insurance premiums. In addition, the House bill cuts over $800 billion from Medicaid over ten years and, in 2020, would end the ACA’s expansion of Medicaid through which some 11 million Americans have gained health care coverage. The bill also eliminates funding for several public health programs aimed at preventing bioterrorism and disease outbreaks.
The AHCA would make a number of changes to the types of health insurance plans that would be available by changing the rules governing protections for those with pre-existing conditions and by eliminating requirements that health plans cover certain benefits. States would be allowed to seek a waiver from the Department of Health and Human Services (HHS) so that insurers could charge higher premiums to those with pre-existing conditions. If HHS does not respond to a state’s request within 60 days, those changes would automatically go into effect. As part of a waiver application, states would have to set up a high risk insurance pool or design a subsidy program of their own for residents with pre-existing conditions who might be priced out of the insurance market as a result of the waiver.
In a letter to the House, PVA expressed concern about a number of the provisions in H.R. 1628 that could have harmful effects on veterans and people with disabilities. Under the bill’s changes to financing of Medicaid, the federal government would no longer share in the costs of providing health care services and community services beyond a capped amount. This would eliminate the enhanced federal match for the Community First Choice Option under Medicaid that provides attendant care services in the community. Thanks to this program, many poor veterans with serious non-service connected disabilities have been able to move from nursing homes into their communities. Data from the Robert Wood Johnson Foundation shows that the Medicaid expansion that would be eliminated by the bill has helped thousands of veterans and their caregivers.
By allowing states to seek waivers that would permit insurers to charge higher premiums to people with pre-existing conditions, people with disabilities and expensive health conditions could again be exposed to significantly higher medical costs. The waivers would also relieve states of the ACA’s requirement that certain essential health benefits must be provided, including crucial services for people with disabilities such as prescription drugs, rehabilitative and habilitative services and devices, preventative and wellness services and chronic disease management. In combination, these changes would very likely make it difficult for people with pre-existing conditions to find affordable plans that cover basic health care services.
For veterans and PVA members in particular, the AHCA continues several problematic policies of the ACA as well as troubling new provisions that could affect the ability of many veterans and their family members to afford health insurance in the private market. Those provisions include:
- Retains coverage of adults up to age 26 on parents’ health policies but continues to exclude CHAMPVA beneficiaries—dependents of the most catastrophically disabled veterans—from this benefit.
- Fails to remove the prohibition on enrollment into the VA health care system for Priority Group 8 veterans, thus denying these veterans access to a viable option for health care.
- Offers tax credits meant to make health insurance affordable to anyone except those eligible for a host of other federal health programs, including those “eligible” for coverage under Title 38 health care programs. This would prevent many veterans who may be “eligible for” but not enrolled in the VA health care system from accessing these tax credits intended to help people buy insurance.
The Senate has begun to discuss parameters of a health care reform bill but is not expected to use H.R. 1628 as the basis for its efforts. Over the coming months, PVA plans to reach out to the Senate committee leadership involved in developing its legislation to ensure that veterans and people with disabilities are not disadvantaged in the process.