On Thursday the U.S. House of Representatives passed the American Health Care Act (AHCA), a bill that repeals the Affordable Care Act (ACA), ends Medicaid as we know it, defunds Planned Parenthood, and kicks 24 million people off of health insurance. The bill barely passed, with 217 Republicans and 0 Democrats voting “Yes,” and 20 Republicans and 193 Democrats voting “No.”
House Republicans forced this bill through without a score from the Congressional Budget Office, without appropriate time for debate, and without the support of the nation’s top healthcare advocacy groups and medical associations, including the American Cancer Society, March of Dimes, AARP, and the new American Medical Association.
By repealing the ACA, they voted to end the cost sharing subsidies that made insurance in the ACA marketplace more affordable and end most of the Obama era taxes that were instituted to supplement the costs of those subsidies, returning hundreds of billions of dollars to the wealthiest Americans. The repeal also removes the individual mandate, which could likely lead to healthier people opting out of purchasing health insurance, causing out-of-pocket expenses for those left with coverage to skyrocket.
The bill that Republicans passed allows states to eliminate the ACA’s requirement that insurers provide Essential Health Benefits, including maternity and newborn care, mental health treatment, prescription drug coverage, access to birth control without co-pays, preventative and wellness visits, chronic disease management, emergency services, and pediatric care, among other critical healthcare services; these are all services on which women disproportionately rely.
Notably, Republicans had originally exempted Members of Congress and their staff from this harmful provision, and were forced to add an amendment revoking that exemption following mass public outrage.
Because Republicans’ original bill was unable to earn the support of the House Freedom Caucus, who felt the bill did not go far enough to remove protections set under the ACA, the bill was updated with an amendment from Republican Tom MacArthur of New Jersey. The MacArthur Amendment does away with protections for people with pre-existing conditions, allowing insurers to once again charge people with pre-existing conditions exorbitant amounts for coverage. Under this bill, pre-existing conditions include sexual assault, domestic violence, C-sections and more, meaning women will go back to paying more for less coverage.
States would be allowed to create “high-risk pools” for people with expensive medical conditions who cannot afford or access health coverage. This approach has many well-known problems. Numerous states attempted high-risk pools for people who could not access coverage, but these attempts resulted in high prices (with some enrollees paying twice as much as healthy people), inadequate coverage, and left many people—by definition people with serious healthcare needs—without coverage at all.
In order to win over the 2-3 moderate votes needed to barely pass the bill, Representative Fred Upton (R-MI) added an amendment that allotted $8 billion over ten years to high risk pools in states that opted to cut protections for pre-existing conditions. Health policy and economic experts agree this amounts to practically no funding to cover millions of sick individuals, yet it was able to sway the votes of a couple moderates who apparently otherwise would have voted against the bill.
This plan also continues to threaten Medicaid, ending Medicaid expansion, drastically cutting Medicaid funding by over $600 billion and instituting block grant funding, leaving states with less money to assist the poorest and sickest Americans. Tens of millions of people will lose coverage through this dismantling of the Medicaid program and women of color in particular would be disproportionately impacted.
In addition, the AHCA bars Planned Parenthood from receiving Medicaid reimbursements, one of the methods Republicans have employed in an attempt to “defund” the healthcare organization. It also further restricts coverage of abortion in the private insurance market by placing restrictions on private insurance companies’ ability to offer comprehensive health care coverage that includes abortion.
The bill now goes to the Senate for consideration.
Media Resources: Feminist Majority Foundation 3/28/17, 4/27/17; NBC News 5/4/17.