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H.R. 1628, the American Health Care Act of 2017

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Health Insurance

Yesterday the House considered H.R. 1628, the American Health Care Act of 2017 or as we’re calling it, Trumpdon’tcare. Late in March, House Republicans abruptly cancelled a vote on this legislation because they knew it wouldn’t pass. The nonpartisan Congressional Budget Office (CBO) analyzed this legislation at the time and determined that 24 million Americans would lose health coverage, including 14 million by 2018. House Republicans rushed H.R. 1628 to the floor yesterday before the CBO could complete additional analysis, necessary because the bill has been amended.

Before getting into how devastating H.R. 1628 is, I want you to know that this legislation gives people earning more than $1 million a year a tax CUT of approximately $50,000! That’s gotten a little lost in everything else bad about this bill, but it needs to be noted.

Q: What’s Changed Since the Last Time?
A: Two Amendments re: Pre-Existing Conditions

Two amendments were added to the original Republican proposal to help buy passage of H.R. 1628. They both address concerns relating to pre-existing conditions.

In order to understand these amendments, a little background may be helpful (simplified, but hopefully understandable). The ACA specifically prohibits denying coverage to someone due to pre-existing conditions. It also prohibits insurance companies from charging different rates in the same coverage area based on the individual medical circumstances of each person — otherwise they would be in compliance with the requirement to “offer” coverage to someone with a pre-existing condition, but could charge unaffordable rates to anyone who has one, which is de facto denial of coverage. This second aspect is called “community rating”. Someone with cancer has a pre-existing condition. So does a person who has had a C-section. If you have allergies, asthma, high blood pressure, diabetes or suffer from migraines, you have a pre-existing condition. You can be denied coverage or charged so much more than your neighbor that health insurance is effectively unaffordable.

First, Rep. Tom MacArthur (R-NJ) offered a devastating amendment that lets states seek waivers from the requirement of “community rating”. As you can see from the explanation above — such a waiver could result in anyone with a pre-existing condition being subject to insurance costs that are unaffordable. A person may be entitled to insurance, but could not afford it.

MacArthur’s amendment also lets states seek waivers from the “essential health benefits” requirements of the ACA, which mandates that insurance companies cover essential services such as pregnancy, emergency room visits, mental health care, pediatric services, rehabilitation and much more. This is how he would reduce the cost of health insurance — by basically covering almost nothing.

The other amendment came from Rep. Fred Upton (R-MI). It adds $8 billion over 5 years (that is about $1.6 billion per year — but only for five years) to help pay those increased insurance costs for people with pre-existing conditions. This sounds nice until we dig deeper. To quote the AARP: “The Upton Amendment to the health care bill, American Health Care Act (AHCA), is not sufficient to protect people with pre-existing health conditions. According to one estimate, it would take $178 billion per year to adequately fund state high-risk pools, where people with preexisting health conditions would go to access health insurance coverage.”

And there is this from the Association of American Medical Colleges: “A modest amount of new funding may incrementally reduce premiums for those with preexisting conditions, but only for five years. Patients will still be at risk, leaving those with cancer, congenital heart conditions, mental illness, or other needs with access to coverage they cannot afford.”

No wonder Republicans would not wait to get the impact report from the non-partisan Congressional Budget Office. Several Republicans have also admitted they didn’t even read the whole bill before they voted for it yesterday.

So What’s the Same as the Last Time?

With all the rightful concern over how this bill has been amended, it’s important not to forget its core elements. Here are just a few:

  • It eliminates the employer mandate. Currently 177 million Americans get their health coverage through their employer who would now be under no obligation to offer it;
  • Americans between 50-64 can be charged up to 5 times more for the same coverage as younger persons;
  • The Medicare Trust Fund is raided to the tune of $175 billion;
  • The legislation eliminates all funding under the ACA for prevention and public health after 2018;
  • The legislation eliminates the requirement that basic mental health and addiction treatment be covered by Medicaid. This will effectively take treatment off the table for people who can’t afford it on their own.

I voted NO. H.R. 1628 passed and the entire vote is recorded below:

  YEA NAY PRESENT NOT VOTING
REPUBLICAN

217

20

0

1

DEMOCRAT

0

193

0

0

TOTAL

217

213

0

1

MASSACHUSETTS
DELEGATION

0

9

0

0



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