San José, CA – On Monday, March 6, the House of Representatives Republican leadership, backed by President Trump, rolled out their plan to repeal and replace the Affordable Care Act (ACA, also known as Obamacare). The Republicans hope to ram their bill, known as the American Health Care Act or AHCA, through congress this month, without an analysis of how many people would lose their insurance coverage or how much it would cost.
The reason for their hurry and why they kept drafts of the bill a secret? The AHCA would cause millions of Americans to lose the health insurance, while millions more would face higher insurance costs. Many hospitals would be put in financial jeopardy and some would have to close because of the costs of treating more uninsured patients.
At the same time the repeal of the ACA would also provide a $600-billion-dollar tax cut for the wealthiest 2.5% of the population, while giving higher income households tax credits that are not currently available under the ACA.
So who loses their health insurance under the Republican plan? First and foremost, it would be lower-income households. Under the ACA, enrollment in Medicaid (health insurance for lower-income households) grew by almost 14 million people to a total of more than 62 million in 2015. This increase would have been even bigger if 19 states, all with Republican leadership, had not blocked the Medicaid expansion in their states. The republican ACHA would cut back on Medicaid by first by cutting back federal aid to states who expanded Medicaid under the Obama’s ACA, and then by converting Medicaid into a block grant to states.
Many lower-income, but not poor, households that are not eligible for Medicaid would also lose their health insurance or end up paying much more. Under the ACA, tax credits to help pay for private health insurance through the ACA exchanges are scaled by income, with lower-income households getting larger subsidies. Under the republican ACHA, a refundable tax-credit is only based on age, not income. Lower-income households would lose subsidies and would have to pay more or drop their health insurance, while higher income households would gain a tax credit that they don’t get under the ACA.
In addition, the republican’s ACHA would allow private health insurance companies to charge older people five times what they charge younger people, instead of the maximum three times under the ACA. This will lead to more expensive health insurance for older Americans, especially those aged 50-65, who are not eligible for Medicare. Some of these people will not be able to afford the higher premiums and be forced to drop their health insurance. But even seniors covered by Medicare will be put at risk, as one of the taxes cut under the ACHA is a source of funding for Medicare. This will worsen Medicare’s finances and open the door to cuts in Medicare in the future.
ACHA also does away with the employer mandate. Under the ACA, larger businesses with more than 50 workers have to provide health insurance to their workers. In just the ten years before the ACA, 12 million workers and their family’s members lost employer health insurance as businesses cut costs to boost their profits. But under the ACA, more than 8 million have regained health insurance from their jobs. The ACHA would lead to millions of workers losing their employer health insurance and either pay much more for private insurance or go without.
One of the problems that the ACA tried to solve was the financial peril of many smaller community and county hospitals, which were straining under the costs of the growing number of uninsured patients. The director of the Ohio Hospital Association estimated that up to 25% of that state’s hospitals would be facing a chronic deficit and face the risk of closing if the ACA were repealed.
Another problem is that the Republican repeal of the ACA would cut a billion dollars from public health programs aimed at epidemics, bioterrorism and immunization. These preventative efforts can and do save billions of dollars in health care costs and an unknown number of lives.
Last, but certainly not least, the ACHA would eliminate funding for Planned Parenthood. Currently Planned Parenthood cannot get government funding for abortion services, which is a very small part of its overall program. But it is a major provider of health care services, especially to lower income women without health insurance.
Right now some major mainstream groups like the American Medical Association that represents doctors, and AARP have come out against the Republican plan. Grassroots and progressive groups will also be mobilizing for what will be the first major legislative fight back against President Trump and the House republican leadership.