Congressional Republicans have revived their bill to repeal the Affordable Care Act. The bill is called the American Health Care Act (H.R. 1628). House Speaker Paul Ryan pulled a previous version of the bill from the House floor in March before a vote could commence because of a failure to gain enough support for the bill.
The latest version of the revived bill includes the additional MacArthur Amendment, named for Rep. Tom MacArthur (R – New Jersey), which allows states to repeal popular ACA regulations.
The updated bill now includes the following:
• New: Allows states to repeal protections for people with pre-existing conditions.
• New: Allows states to repeal Essential Health Benefits, rules that require insurers to cover a set of services, including hospital care, prescriptions, pregnancy, and mental health care.
• The nonpartisan Congressional Budget Office expects the bill to cause 24 million people to lose their health insurance by 2026.
• Drastically reduces tax credits that help low-middle income families buy health insurance. Adults over age 50 would be hit the worst.
• Completely repeals Cost-Sharing Reductions that help the lowest income families afford their deductibles, copays, and coinsurance.
• Cuts Medicaid funding by $839 billion over the next 10 years, and permanently changes how Medicaid funding works, shifting costs and risk to states.
• Effectively repeals Medicaid Expansion by cutting off enhanced funding that helps states cover the cost. In Pennsylvania, over 700k individuals would lose their Medicaid coverage.
• Tax credits could not be used to purchase plans that cover abortion care. Women in states that require insurers to include this coverage on all plans may be ineligible for tax credits under this bill.
• Repeal all revenue features of the ACA, cutting taxes for wealthy people with incomes over $1 million per year.
States could repeal Essential Health Benefits, a list of 10 medical services that insurers are now required to cover. The list includes things like hospital care, doctor’s visits, emergency room, pregnancy care, and treatment for mental health or substance use disorders. This is dangerous not only because consumers would be at risk for not finding comprehensive coverage, but because the ACA’s ban on annual and lifetime coverage limits is tied to Essential Health Benefits. If states repealed EHBs, insurers will also be able to once again deny treatments or cut off coverage like chemotherapy because it’s too expensive.
States could repeal protections for people with pre-existing conditions. One of the most popular ACA provisions prohibits insurance companies from punishing sick consumers with higher prices or refusals to cover pre-existing health conditions. The repeal bill now allows states to remove these protections, simply by obtaining a waiver from HHS. Technically, states must state that they’re providing another way to help consumers obtain coverage. But, there is no federal review process to evaluate the claims. Waiver approval would be automatic after a 60 day waiting period.
Supporters of the amendment claim that consumers with pre-existing conditions would not be in danger because states could choose to keep protections intact. However, no states implemented these protections on their own before the ACA. Consumers in states with Republican-led legislatures would be in jeopardy. The latest election in Pennsylvania gave Republicans a veto-proof majority, so consumers should be concerned.
None of the changes to the repeal bill address any of the problems raised from consumer advocates with the original version.
Here’s what you can do to stop this bill and protect the ACA:
• Contact your representative! Find your Congressional Representative’s contact information.
• Get out your pen! Write a letter to the editor in your local newspaper. Every legislator reads the paper, and many others in your community do too.
• Check out the Advocacy section of our website for more ideas.
About the Author
Cassie Narkevic is a Health Care Navigator at Consumer Health Coalition.