House Republicans introduced a replacement plan for the Affordable Care Act on Monday that will hurt the country’s most vulnerable populations.
The American Healthcare Act would phase out Medicaid expansion under the ACA, gets rid of the individual mandate, charges a 30 percent premium surcharge to people without continuous coverage in the individual market, and defunds Planned Parenthood.
Americans most affected by this plan are women, low-income people, the elderly, and people with mental illnesses — but it’s likely that all Americans will lose out under this plan.
Under the American Healthcare Act, Planned Parenthood is barred from using federal funding for family planning and Americans would not be able to use their tax credits to help them pay for plans that include abortion services. This would leave low-income women to pay for an abortion and other family planning services out of their own pockets.
Planned Parenthood receives about $500 million each year from the federal government, and 60 percent of the women’s health organization’s funding comes from Medicaid and Title IX funding for preventative care and primary care. Almost 400,000 women would lose access to preventative care and up to 650,000 would have reduced preventative care within year if Medicaid patients could not receive Planned Parenthood services, according to an estimate from the Government Accountability Office.
Research has shown that when low-income have access to free contraception, there are significantly lower rates of unintended teen pregnancy and abortion. When cost is no longer a barrier for women, they chose more effective and longer lasting forms of birth control. Defunding Planned Parenthood would likely result in more unintended teen pregnancies.
Low-income and chronically sick people
Through introducing massive cuts to Medicaid and allowing insurers to add a 30 percent surcharge to premiums if people go without insurance for too long, the House Republicans’ plan would also hurt low-income Americans, especially if they have chronic diseases.
The plan would phase out Medicaid expansion under Obamacare and would officially end that expansion in 2020. Thanks to Medicaid expansion, Medicaid coverage for people with HIV rose from 36 percent in 2012 to 42 percent in 2014, according to the Kaiser Family Foundation. Prior to the ACA, low-income people living with HIV could only qualify under Medicaid when they had advanced HIV, and were developing AIDS, even though access to treatment could “stave off disability,’ KFF explained.
A 30 percent surcharge to premiums would also hurt the chronically ill, because research shows that 85 percent of cancer patients stop working when they receive treatment, leading to gaps in coverage.
There is evidence that people of color and low-wage workers, such as dishwashers and cashiers, have benefited from the ACA. A New York Times investigation last year found that there were historic increases in coverage for low-wage workers in the first full year of the ACA. Latinos accounted for almost a third of the increase in people with insurance.
In addition to all of these provisions affecting low-income and chronically sick people, the House GOP plan provides a tax break to insurers that pay CEOs over $1.5 million per year.
The House GOP health care plan also benefit younger Americans more than older Americans. Under the ACA, insurance companies can charge their oldest customers prices three times those of younger customers, but under this plan, insurance companies would be allowed to charge elderly Americans up to five times more than young people.
As a result, annual premiums would rise 22 percent for people between the ages 60 to 64 and people in their 50s would see a 13 percent in annual premiums, according to the AARP Public Policy Institute.
Under this plan, the tax credits are weighed by age and not income, so a 30-year-old would receive $2,000, and a 60-year-old would receive $4,000. But generally speaking, older and lower income Americans received larger tax credits under the ACA than its replacement, according to the Kaiser Family Foundation. Sixty-six percent of those enrolled in Healthcare.gov have incomes at or below 250 percent of poverty, or $31,250 for a single person in 2020, and 27 percent are 55 years old or older.
People suffering from mental illness
The phasing out of Medicaid expansion would also hurt Americans with mental illnesses and substance abuse disorders, four Republican senators wrote in a letter to Senate Majority Leader Mitch McConnell (R-KY). Sen. Shelley Moore Capito (R-WV), Sen. Lisa Murkowski (R-AK), Sen. Rob Portman (R-OH), and Cory Gardner (R-CO) wrote, “We believe Medicaid needs to be reformed, but reform should not come at the cost of disruption in access to health care for our country’s most vulnerable and sickest individuals.”
Thirty-five percent of low-income Medicaid beneficiaries, and 13 percent of non-elderly adult beneficiaries have a chronic mental illness. Spending by Medicaid made up 25 percent of total mental health spending and 21 percent of spending on treatment for substance abuse disorders in 2014, according to the National Council for Behavioral Health.
Over forty million adults in the United States have a mental health issue and 19.7 million have a substance abuse problem, according to a 2014 report from the advocacy group Mental Health America.
House Republicans have acknowledged that without the mandate, fewer people will have access to insurance. Congressional budget analysts and the White House’s Office of Management and Budget show that the plan’s tax credits wouldn’t provide enough assistance to low-income people, according to The Washington Post.
Republicans released the bill before receiving any Congressional Budget Office score. It’s unclear how much the bill would cost or exactly how many people would lose coverage, but one thing is certain: Fewer Americans would have coverage under the House Republican plan.
Larry Levitt, senior vice president of the Kaiser Family Foundation, said there is no way the Republican plan would cover as many people as the ACA and Andy Slavitt, the former Acting Administrator of the Centers for Medicare and Medicaid Services under the Obama administration said the plan will result in a “death spiral.” A “death spiral” is a term for when health care costs continue to rise, causing low-risk enrollees drop out of the plan, which drives premiums even higher, so that eventually no one can afford health care, and the collapses.
With Medicaid reductions and smaller tax credits, there's no way the House GOP bill covers as many people as the ACA.
— Larry Levitt (@larry_levitt) March 7, 2017
Headline 3: The math for AHCA is faulty. It leads to bad risk & a death spiral which means pre-ex protections are likely on paper only. 9
— Andy Slavitt (@ASlavitt) March 7, 2017
Other health care experts have held these concerns after looking at previous Republican plans to replace the ACA. In January, the CBO examined a scenario in which Congress got rid of the ACA’s individual and employer mandate and repealed Medicaid expansion after two years but kept coverage of preexisting conditions. The CBO predicted that 18 million people would lose insurance within the first year.