A Republican “Health Care” Plan for the Affluent

March 24, 2017
Guest Post

by Jeremy Leaming, Director of Communications, National Health Law Program

Despite growing public opposition to the so-called American Health Care Act (AHCA), House Republicans are striving to unite behind the bill that includes provisions that not only repeal the Affordable Care Act, but gut Medicaid, shifting health care costs to state governments and cutting off health care coverage to tens of millions of Americans. At this moment the measure is still being tweaked to please hardcore conservatives whose only agenda is to kill entitlement programs and pass laws that coddle the wealthy.

In the House, the Tea Party faction called the Freedom Caucus, has been agitating for a full repeal of the ACA, including its Medicaid expansion. Although the faction appears to be balking at these efforts, it seems safe to assume that House Republicans will eventually unite behind this atrocity. If by chance the bill would die in the House or languish in the Senate, Politico’s Dan Diamond notes that the Trump administration will continue to do serious damage to the ACA.

Increasingly the media and public have caught on to the fact that House Republicans are seeking more than just a repeal of the President Obama’s landmark health care reform law – one that has brought health care coverage to more than 20 million Americans and dropped uninsured rates to the lowest in 50 years. The AHCA includes provisions that would end Medicaid as we know it. The National Health Law Program, which has defended Medicaid for almost 50 years, has provided numerous reports on the provisions in AHCA that would affect Medicaid. For example AHCA envisions ending Medicaid as an entitlement program by slashing its federal funding either with per capita caps or block grants. Mara Youdelman, managing attorney of NHeLP’s DC office, explains how per capita caps would shift health care costs to states, forcing them to cut health services and/or limit those who are eligible for Medicaid. Republicans argue that these provisions are intended to give state’s more “flexibility” in how they provide health care to low-income individuals in their states. But with far less federal funding, states will not have a lot of options – either find ways to pay for quality health care services or cut services. Many states – led by conservative lawmakers – will opt for cutting health care services.

Indeed as Gabriella Gurley for The American Prospect notes in this piece, there is no state that will be able to handle “reduced federal funding coupled with fast-rising medical costs. The outrage that has greeted the Republican proposal to topple one of the pillars of the American health-care system reflects the growing realization that the plan jeopardizes the health of millions of people and compromises the economic stability of the states where they live.”

Medicaid, which covers more than 70 million people, including 36 million children and 16 million people with disabilities and older adults, has long been attacked by many on the right as providing inferior health care service to Americans. But those claims do not withstand scrutiny. NHeLP’s Sarah Somer’s explains in this piece, “Medicaid is a successful program that has been providing lifesaving benefits to covered beneficiaries for half a century. Recent reports provide new evidence of this success. While there are access problems for some services in some parts of the country, Medicaid access far outpace that of the uninsured and is comparable to private insurance in many ways.”  

The Congressional Budget Office reported that AHCA would result in $880 billion being cut from Medicaid within a decade, an outcome to please conservatives – because it would help pay for more tax breaks for the rich. But such draconian cuts would likely not go over well with a broad section of people. Indeed a recent Kaiser Family Foundation poll found that Medicaid and its expansion have broad support. For instance in “the 16 states with a Republican governor that expanded Medicaid, 87 percent of residents said it was important that federal funding for the expansion be maintained.

The CBO also estimated that AHCA would cause at least 24 million people to lose health care coverage. Because of the rabid Freedom Caucus another provision is being discussed, one that would repeal the ACA’s Essential Health Benefits (EHBs), which require ACA marketplace plans to cover a core set of services, such as ambulatory patient services (outpatient care), hospitalization and prescription drugs, as NHeLP’s Senior Attorney Michelle Lilienfeld notes in a piece that explains how the elimination of EHBs would drive up the number of uninsured. She continues, “If the EHB standard is eliminated, health care coverage will likely be insufficient and, once again, leave many consumers facing higher costs and less access to basic health care.”

On the campaign trail Donald Trump promised no one would lose health coverage under this health care bill, now he is trying to bully lawmakers into advancing a measure that if enacted would cause tens of millions of Americans to lose health coverage. Politicians are prone to break campaign promises, and Trump is apparently betting that cutting tens of millions of individuals off of health care coverage is no big deal.