Trumpcare: What The AHCA Means For You
On a crisp fall day in October of last year, former President Barack Obama spoke to a raucous crowd at Miami Dade College. He was campaigning for Hillary Clinton at the time, but chose to focus the majority of his speech on his greatest personal victory in office — the passing of the Affordable Care Act. He wanted to remind voters why healthcare was such a big deal for him during his tenure as President:
“It was because of you. It was because of the stories that I was hearing all around the country, and right here in Florida — hearing from people who had been forced to fight a broken health care system at the same time as they were fighting to get well.
It was about children like Zoe Lihn, who needed heart surgery when she was just 15 hours old — just a baby, just a infant. And she was halfway to hitting her lifetime insurance cap before she was old enough to walk. Her parents had no idea how they could possibly make sure that she continued to make progress. And today, because of the Affordable Care Act, Zoe is in first grade and she’s loving martial arts. And she’s got a bright future ahead of her.”
Today, the House narrowly approved a measure to repeal and replace the Affordable Care Act. This is the first successful step the GOP has taken towards fulfilling one of Donald Trump’s heaviest campaign promises:
“One thing we have to do: Repeal and replace the disaster known as Obamacare. It’s destroying our country. It’s destroying our businesses”
After a failed vote in March, Congressional Republicans spent this afternoon celebrating their victory with Bud Light and schmoozing in the Rose Garden.
So, if you’re part of the rest of the country who is just getting off work and wondering why their leaders are suddenly acting like college frat boys, you’ve come to the right place. In this first installment of Deconstructed, we look at exactly what went down in Washington today, and whether or not you need to be stocking up on your first aid kits.
Who the AHCA Affects
The first question that generally comes up in the complex discussion of federal healthcare is who will stay covered and who will not. This new bill, or the American Health Care Act as it’s officially known, is the GOP’s third attempt to get new healthcare legislation through the House. Because of the GOP’s push to get the AHCA passed before the House breaks for recess on Friday, the non-partisan Congressional Budget Office has not reviewed the bill to determine who exactly will lose coverage and how much it will cost. However, an early form of this legislation was estimated to strip coverage from around 24 million more people by 2026.
While we don’t know the total number of people who would lose coverage under this version of the AHCA, we do know which groups who would fair the worst — generally these consist of the most vulnerable around us. This isn’t a surprise, considering the GOP’s affinity for reminding people to pull themselves up by their bootstraps, pre-existing conditions be damned. Here’s a list of those whose loss of coverage House Republicans were drinking to today.
When the AHCA failed to come to a vote back in March, it was mainly because the conservative Freedom Caucus wasn’t satisfied with the severity of the bill. As a concession this time around, moderate Republican Tom MacArthur negotiated an amendment that would allow states to obtain waivers from certain Obamacare regulations, including the “essential benefits package that defines acceptable insurance, and the community rating provision that forces insurers to charge the same rate for all applicants.”
This means anyone with a pre-existing condition can basically be priced out of market if their state decides to obtain one of these waivers. The term pre-existing condition is so terribly vague that it can be used to cover just about anything — including cesarean sections, a procedure which approximately 33% of American mothers undergo. C-Sections can lead to further health complications, such as a higher risk of post-surgery complications. Under the AHCA, if a woman has given birth by means of a C-Section at some point in her life, she is now at risk of losing her insurance coverage.
Postpartum depression, which affects approximately 1 in 7 women after giving birth, is also considered a pre-existing condition. If this bill progresses further through Congress, companies could concurrently “deny coverage for gynecological services and mammograms.”
Domestic Violence/Rape Survivors
Domestic violence and sexual assault can lead to a greater need for mental and physical healthcare. Because of this — and I’m sure you guessed it — they both could count as pre-existing conditions under the AHCA. The bill doesn’t explicitly forbid insurance companies from penalizing you for the countless side-effects of domestic violence and sexual assault — leaving survivors open to being considered a pre-existing condition. The problem with this language is that it puts the entire definition of “pre-existing conditions” in the hands of the insurance companies, leaving the most vulnerable at the whim of corporations seeking to make the highest profit.
The MacArther Amendment has language stating,
“Nothing in this Act shall be construed as permitting health insurance issuers to discriminate in rates for health insurance coverage by gender.”
However, when the majority of Americans affected by these conditions are women, one has to wonder how little Republicans think of some of their constituents.
Children with Disabilities
While the loss of coverage for those with pre-existing conditions is one of the loudest negatives of the AHCA, the deep cuts to Medicaid would also have disastrous consequences. For the past 30 years, Medicaid has helped public school systems pay for disability services — from physical therapists to preventive care for eligible children. Under new entitlement reforms, the AHCA would cut funding by $880 billion and no longer require states to view schools as eligible Medicaid providers — meaning they would be unable to seek reimbursements for healthcare related expenses.
While speaking with a National Review reporter, Speaker Paul Ryan touted these Medicaid cuts as one of his lifelong dreams,
“We have been dreaming of this since I have been around, since you and I were drinking at a keg.”
Employees Who Get Their Insurance Through Work
If you thought you were exempt from this debate because you get your insurance through work, think again. Another waiver which states could obtain would destroy protections that limit employees’ out-of-pocket costs for catastrophic illnesses.
Employer health plans are the single-largest source of coverage in the United States, with approximately 160 million Americans receiving coverage through their work, according to a report in the Wall Street Journal. Employers in states that receive these waivers would be exempt from covering “10 specific types of health services, including maternity care, prescription drugs, mental health treatment and hospitalization.”
A handful of moderate Republicans who are up for re-election expressed concern over the MacArthur Amendment, as it seemed to present healthcare as only affordable for the healthy (spoiler alert: they were right. In response, MacArthur claimed that no state would be able to receive a waiver unless they were able to figure out a way to provide coverage to those with pre-existing conditions.
The main way this is done? High-risk pools — known more colloquially as death panels. High-risk pools are privately funded, state-organized health insurance plans which are supposed to provide coverage to individuals who don’t have access to group insurance because of pre-existing conditions. The problem is that these cost a ton of money and have failed basically every time they’ve been used. They’ve been historically underfunded and rarely able to actually provide care for those who most need it.
Senate Minority Leader Charles E. Schumer explained it quite bluntly,
“High-risk pools are the real death panels: they mean waiting forever in line for unaffordable health insurance.”
When the Congressional Budget Office scored the previous version of the AHCA, they noted that the group that would be most affected were citizens ages 50 and older. The percentage of uninsured elderly would skyrocket from 13% to 30% in ten years under new provisions. To put that in perspective:
AARP Executive Vice President Nancy LeaMond issued this statement in response to today’s events:
“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, 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 preexisting conditions, such as cancer and diabetes, who would likely find health care unaffordable or unavailable to them.”
In an attempt to hold lawmakers accountable, AARP will begin to notify it’s 38 million members if their representatives voted for the AHCA. For those who don’t want to wait to be notified, here’s a breakdown of the final vote tally.
Surprisingly, there are some people coming out of today’s vote looking better than they did before. Unsurprisingly, these are basically the top one percent of American taxpayers. A repeal of the Affordable Care Act’s tax provisions would immediately provide some of the wealthiest Americans with a tax cut totaling “$346 billion over 10 years,” as reported by the Los Angeles Times. These cuts would exclusively be handed to taxpayers earning more than $200,000 a year ($250,000 for couples).
According to a study conducted by the nonpartisan Tax Policy Center, repealing Obamacare taxes would benefit wealthy families five times more than those in the middle class. And before you start googling how much your Congressman gets paid, they’re a couple steps ahead of you.
The ACA currently requires all members of Congress and their staff to purchase health insurance through the public marketplace. This means the new MacArthur Amendment would apply to them, too. Now, if you’ve made it this far you know that the MacArthur Amendment pretty much sucks for anyone with a pre-existing condition — so, members of Congress decided not the apply it to themselves. Those Obamacare era regulations that provided a safety net for people with pre-existing conditions? Gone for everyone, except if you happen to be elected to Congress.
The American Health Care Act benefits two groups of people — the wealthiest few, and the men and women who voted on it today.
Hope for the Future?
Passing the House is only the first step needed to make the AHCA law. The bill is bound to be rewritten in the Senate, although it’s exact future is unknown. Republicans can afford to lose only two votes in the Senate, so finding the balance between appealing to both the conservative and moderate side of the party will be difficult. The steep spending cuts are bound to be moderated, and the bill will then have to be put through the House again.
What this means for you is that there is still time to voice your opinion to your Congressman. There is still time for calls to be made, for letters to be written, for constituents to stand up and demand that they are represented accurately and justly. The wheels of government turn slowly, and that allows us to remind the men and women in the House that they are public servants whose job is to listen to the people that put them in office.
So if you’re mad, if you’re scared, if you don’t understand why the people who are supposed to serve the public decided today that health care is for the very few — remember another thing our former President said on that fall day in Florida.
Don’t boo. Vote.
Search here to find your Senate representative, and remind them that they work for you — and if they don’t fulfill their duties to the public, the public will find someone who will.