This week the American public got their first look at the Republican proposed budget reconciliation bill that would begin the unraveling of the Affordable Care Act (ACA).

By Thursday it had been approved along party lines by the House Energy and Commerce Committee and the Ways and Means Committee. The bill, which does not yet have a score from the non-partisan Congressional Budget Office, now heads to the House Budget Committee before an expected floor vote at the end of the month.

The reconciliation bill repeals the cost sharing subsidies that made insurance in the ACA marketplace more affordable, and initiates tax credits based on age instead of income bracket. All of the Obama era taxes that were instituted to supplement the costs of the subsidies would be repealed, making it impossible to pay for any kind of ACA “replacement,” according to the Brookings Institute. The bill removes all tax penalties for individuals who do not purchase health insurance and large companies that do not offer it to their employees, essentially assuring that healthier customers drop out, leaving the sick to pay higher rates.

Under this bill, if anyone does not stay continually covered by health insurance, despite a potential increase in rates or a change in employment status, they can be charged a late enrollment penalty.

As of December 31, 2019, the reconciliation bill calls for the sunset of rules that currently require insurance companies to cover benefits such as hospitalization, maternity care and mental health services, effectively putting it on the states whether or not to mandate that coverage from insurance providers. Also by 2020, Medicaid as we know it would end, as block grant funding is instituted, leaving states with increasingly less money to assist the poorest and sickest Americans.

As promised, the bill blocks Planned Parenthood from receiving Medicaid reimbursements. But it also goes one step further, entering women’s healthcare options in the private market by denying tax credits to people who purchase health insurance plans that cover abortion care, most likely leading to insurance companies dropping it all together, as most women would be left unable to afford such a plan.

President Trump notably offered to save Planned Parenthood from funding cuts on the condition that they no longer provide abortion services to their patients. Cecile Richards, president of Planned Parenthood Federation of America, made clear in a statement that that was never going to happen, adding, “We are glad that the White House understands that taking away the preventative care Planned Parenthood provides is deeply unpopular and would be a disaster for women’s health care.”

Medical experts and policy analysts are still pouring over the new bill, as Republicans promise that it is simply the first of multiple repeal efforts that they will pursue in this Congress.

Media Resources: New York Times 3/9/17; LA Times 3/6/17; Kaiser Family Foundation;  Vox 3/7/17

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