I’m a Public Health Professional. This is How TrumpCare Will Hurt the Most Vulnerable.
May 31, 2017
By Ariel Smilowitz
Last week, the Congressional Budget Office released its new score on the American Health Care Act (AHCA), which was recently passed by the House of Representatives after months of controversy and political infighting.
This is far from the first attempt by Republicans to deregulate our health care system. Since the passage of the Affordable Care Act (ACA) in 2010, the Republican Party has tried over 50 times to overturn the law, despite the fact that more than half of Americans approve of the ACA.
Recently, organizations within the health care industry – along with attorneys general from 15 states and the District of Columbia – wrote a letter to Senate Republican and Democratic leaders urging them to reconsider passing legislation that could lead to 23 million Americans moving “to the ranks of the uninsured.”
In my experience as a public health professional, I have rarely seen doctors, hospitals, consumer groups, and insurance providers— groups that normally have very different legislative aims —united in stance on a piece of legislation. It is clear across the board that this legislation is deeply problematic and completely detrimental, not only to those who are most vulnerable, but to everyone in this country who seeks care. By making it more difficult to receive preventative, comprehensive health services on a regular basis, people will ultimately get sicker and only attempt to seek care when their illnesses become acute, resulting in higher expenditures and lower quality care.
As attorney generals lament, the Trump Administration “has increasingly made clear that [it] views decisions about providing access to health insurance…as little more than political bargaining chips.” The AHCA’s changes to Medicaid financing – which include per-person caps on states’ annual funding and state-driven caps via block grants – will eventually result in an $880 billion reduction over the next nine years, effectively punishing the most vulnerable in this country. Here’s how those groups will fare if TrumpCare becomes reality.
The Poor and Sick
According to a recent report by the Kaiser Family Foundation, the AHCA could lead to higher premiums for millions of people with pre-existing conditions like cancer, HIV/AIDs, mental disorders, obesity, and diabetes, to name a few. Previously, the ACA prohibited medical underwriting (basing premiums on consumers’ health status) through its community rating provision; now, the ACHA allows states to waive out of this provision and charge sicker people higher premiums if they have a break in health coverage of 63 or more consecutive days.
Alas, the Kaiser Family Foundation’s analysis revealed that six million people with pre-existing conditions had at least a two-month coverage gap in 2015. In many cases, people experience these gaps when they lose a job with health benefits or suffer a decrease in income that makes coverage less affordable. For those who are poor or unemployed and can’t afford continuous coverage, or for those who have pre-existing conditions, there is a much greater chance that they will either be denied health insurance or have to pay even more for care.
The AHCA essentially imposes an age tax on consumers, by allowing insurers to charge older adults five times what younger people pay for health insurance and by reducing tax credits that help older adults afford coverage. This tax will likely jeopardize health coverage for near-elderly adults with low-incomes, a group that is most likely among all non-Medicare enrollees to be sick.
Women and Children
In addition to classifying pregnancy as a pre-existing condition (which will lead to higher premiums for a majority of women in the U.S.), the AHCA provides states with the option to opt out of the ACA’s essential health benefits requirement, which requires insurance plans to cover wellness services and chronic disease management. What’s more, as Roosevelt Fellow Andrea Flynn mentions in a recent policy brief, the AHCA will defund Planned Parenthood for one year, stripping access to primary and preventative care for millions of women and girls.
Finally, children – who make up about half of the entire Medicaid population – will arguably feel the cuts in long-term Medicaid spending the most. One program at risk under the AHCA is the Early Periodic Screening Diagnosis and Treatment benefit, which provides comprehensive services—such as in-home care and behavioral screening—that are critical for ensuring children receive appropriate preventative, developmental, and specialty care. If states accept the Medicaid block grant, children will likely lose this benefit and receive less comprehensive care. Additionally, schools that are reimbursed by Medicaid for providing services to children with disabilities will be threatened by these cuts as well.
It is rare but encouraging to see so many groups within the health care industry come together to oppose TrumpCare. This uncommonly large opposition suggests that it is entirely within our power to ensure that the AHCA – as it currently stands – does not pass. We all need to read up on what is at stake, call and protest our senators, and donate to Planned Parenthood and other local health organizations providing life-saving care. As the Senate contemplates this bill, we must urge them to keep our best interests in mind and at heart so that millions of Americans are not robbed of their right to good health.