The House on Thursday voted 217-213 to replace the Affordable Care Act — or Obamacare — with the American Health Care Act.
Despite changes made so that the bill would pass, it will still negatively impact millions of Americans. And none of the provisions in the AHCA take effect until 2018, with most of the changes not actually occurring until 2020 and any significant impacts being seen until then — after, incidentally, midterm elections will take place in November 2018.
Notably, the new bill could harm people with preexisting conditions. Under Obamacare, an insured could not be denied coverage or treatment or charged a more expensive rate due to a preexisting condition. An amendment from New Jersey Rep. Tom MacArthur for the AHCA, however, allows states to opt out of this requirement. States that obtain a waiver will instead have to provide high-risk insurance pools to alleviate the extra costs — $8 billion over five years, which experts say is nowhere near enough.
Preexisting conditions can include a wide variety of medical issues, such as asthma, diabetes, cancer, heart disease, cerebral palsy, high cholesterol, fibromyalgia and sickle cell disease.
Under the new plan, Americans will no longer be required to purchase medical insurance but will be provided a tax credit between $2,000 and $4,000, depending on the individual's age, with older people receiving a higher credit. The amount does not vary by state, making the credit more valuable in areas with lower healthcare costs.
Premiums will be higher for older Americans. Under Obamacare, insurers were able to charge a 64-year-old three times more for a policy than a 21-year-old. The AHCA will allow insurers to charge the older population five times more than younger people. According to CNNMoney, states will be able to obtain waivers to charge even more than five times the amount.
In addition to eliminating the requirement to protect those with preexisting conditions, the bill also allows states to opt out of providing essential health benefits that were required to be covered under Obamacare.
The full "essential health benefits" are:
- Prescription medication
- Emergency services
- Hospitalization and surgery
- Laboratory services
- Mental health services, such as behavioral therapy, counseling, substance abuse treatments and psychotherapy
- Outpatient care, which is also called ambulatory patient services
- Pediatric care, including dental and vision
- Prenatal and postnatal care
- Preventive care in the form of general wellness checkups and chronic disease management
- Rehabilitative care, including necessary equipment and devices
In addition, the bill will harm Medicaid recipients. The bill will allow states to require Medicaid recipients to work or partake in community service or job training. Obamacare did not require recipients to work to be eligible for the program.
According to a Kaiser Family Foundation analysis, nearly 8 in 10 adults on Medicaid live in working families. Of the more than 70 million Medicaid enrollees, about 9.8 million do not work. Thirty-five percent report an illness or disability that prevents them from working, and 28 percent have at-home and/or family responsibilities that prevent them from working. Eighteen percent are going to school, 8 percent are retired, 8 percent could not find work, and 3 percent reported a different reason.
The new bill would also give states the option to receive block grants for Medicaid recipients, no matter how many people in the state are enrolled. Additionally, states would have the option to immediately cease the expansion of Medicaid instead of waiting until 2020.
The bill also takes away money for Planned Parenthood, which many people depend on for birth control, treatment for sexually transmitted infections and diseases, pap smears and cancer screenings. According to the organization, 60 percent of its patients rely on Medicaid and similar public health programs.
Planned Parenthood also estimates that its centers prevent nearly 580,000 unplanned pregnancies each year.
The Congressional Budget Office (CBO) previously estimated that the bill will leave millions uninsured compared to if Obamacare were to be left in place.
Democrats, who unanimously voted against the measure, came out strongly opposing the bill.
"Make no mistake, many people will die as a result of this bill," said Rep. Debbie Wasserman Schultz (D-Florida).
"I have never seen political suicide in my life like I'm seeing today," said Rep. Louise M. Slaughter (D-N.Y.).
Many groups previously expressed their disapproval of the bill, and some, including AARP, doubled down on this position.
AARP Executive Vice President Nancy LeaMond said in a statement, "AARP is deeply disappointed in today's vote by the House to pass this deeply flawed health bill. The bill will put an Age Tax on us as we age, harming millions of American families with health insurance, forcing many to lose coverage or pay thousands of dollars more for health care. In addition, the bill now puts at risk the 25 million older adults with pre-existing conditions, such as cancer and diabetes, who would likely find health care unaffordable or unavailable to them."
Paul Markovich, CEO of Blue Shield of California, called the bill "flawed" and said it "could return us to a time when people who were born with a birth defect or who became sick could not purchase or afford insurance." He also agreed that the $8 billion proposed to help with the high-risk insured pools will not be enough money.
California Healthline reported:
"More broadly, Markovich said the GOP bill would make health insurance unaffordable for millions of Americans by significantly reducing the premium tax credits consumers rely on. He also warned that the GOP's proposal to deeply cut Medicaid would place an 'impossible' fiscal burden on states such as California, 'resulting in millions more people without access to care.'"
The percent of Americans living with preexisting conditions varies and depends largely on the definition of the phrase being used. According to the U.S. Department of Health and Human Services, as many as 1 in 2 non-elderly Americans live with a preexisting condition. (Using a more conservative estimate, the department reported that nearly one-fifth of non-elderly Americans live with some kind of preexisting condition.) A Kaiser Family Foundation analysis found that just over one-quarter of U.S. adults under 65 live with a preexisting condition "that would likely make them uninsurable" without the ACA. But, in a separate Kaiser Family Foundation poll, "most people (53%) report that they or someone in their household has a pre-existing condition."
"Older Americans between ages 55 and 64 are at particular risk: 48 to 86 percent of people in that age bracket have some type of pre-existing condition. And 15 to 30 percent of people in perfectly good health today are likely to develop a pre-existing condition over the next eight years, severely limiting their choices without the protections of the Affordable Care Act," the HHS reported.