Most recently, the Affordable Care Act (ACA) of 2010 added protection of that right for more than 24 million Americans[1] who still did not have affordable and comprehensive care and protected 52 million people with pre-existing medical conditions. Now, the American Health Care Act, passed on May 4 by the U.S. House, and the Better Care Reconciliation Act, introduced in June into the U.S. Senate, have threatened not just to roll back the ACA and its protections but to deny coverage under the ACA and Medicaid to 23 (House) or 22 (Senate) million Americans. It also will upend insurance markets, savage state budgets, drive up unemployment, and badly impact rural communities.
Senators promised that their bill would be different from that of the House, and President Trump termed the House Bill “mean.” The Senate, however, kept most of the terrible House provisions and their negative consequences[2]:
• Tens of millions of people lose health coverage.
• Millions of low-income adults lose Medicaid expansion.
• Medicaid for seniors, people with disabilities, and children is capped and cut.
• Tax credits are cut and premiums raised by thousands of dollars for many older people.
• Individual market premiums rise by 20 percent for 2018.
• Insurers can drop coverage for maternity care, mental health, and substance abuse.
• Opioid addiction coverage is cut by billions of dollars.
• Survival of rural hospitals dependent on Medicaid is threatened.
• Employer and individual mandates to purchase insurance will be ended.
On July 13 the Senate’s second version, while reversing two House tax cuts, still included nearly $400 billion in tax cuts primarily for high-income households and corporations, including new tax cuts for Health Savings Accounts. The core of the bill remained tax cuts for the wealthy and corporations financed by cutting assistance to help millions of low-and moderate-income families afford health coverage.[3] This bill retained the massive cuts to Medicaid that made the House and first Senate bills so morally repugnant. It provoked negative responses from insurance companies, patient groups, the U.S. Catholic Bishops, and health care provider groups such as the Catholic Health Association.
Then, on Monday, July 17, four Republican senators indicated they could not support the bill, ending the likelihood of its passing. Now the Senate apparently will cast a vote next week just to end the ACA and then get around to replacing it in the next two years.
This turns the clock back, not a decade but 50 years. It would end the Medicaid guarantee of the 1960s that, if you meet state eligibility standards, you have a right to coverage. The House bill ends that guarantee by block grants and the Senate bill by “per capita caps.” The outcome is the same, rolling back the Medicaid expansion under the ACA and severely cutting all Medicaid funding by 26 percent in the next ten years and by 35 percent in the following decade in the Senate proposal.[4]
The non-partisan Congressional Budget Office found that a repeal-only bill would cause 32 million more people to be uninsured by 2026, double insurance premiums, and virtually collapse the individual market.
Why would Congress do this? The fundamental rationale for moving legislation forward under special budget rules is to provide billions of dollars of tax cuts to wealthy taxpayers and corporations in this bill and the upcoming tax “reform” package. They will prosper even more while tens of millions of Americans suffer.
We must tell our senators today (call Senate switchboard at (202) 224-3121):
a. Vote against any repeal or "repeal and replace" bill.
b. Preserve Medicaid and support the Medicaid expansion.
c. Maintain individual and employer mandates to keep health insurance more affordable.
d. Forbid insurers from limiting benefits to anyone with pre-existing conditions, reducing essential core benefits, or charging higher premiums to older adults.
e. Preserve the subsidies that help people purchase insurance in the state or federal marketplaces.
