The American Health Care Act of 2017 (H.R. 1628)

Background:

On March 23, 2010, President Obama signed comprehensive health reform, the Patient Protection and Affordable Care Act (ACA), into law. The law focused on expanding health care coverage for millions of Americans, making coverage more affordable by controlling health care costs, and seeking to improve the overall healthcare delivery system. The ACA requires U.S. citizens and legal residents to have health insurance, creating a penalty of roughly $700 per year for failing to do so (this rule is called the Individual Mandate). The bill created state-based American Health Benefit Exchanges through which individuals can purchase coverage, with premium and cost-sharing credits available to individuals/families with income between 133-400% of the federal poverty level (the poverty level is $19,530 for a family of three in 2013) and created separate Exchanges through which small businesses can purchase coverage. Small businesses (those with no more than 25 employees) receive a tax credit of up to 50% of the employer’s contribution towards employee health insurance premiums.  Under the ACA, the government provides subsidies for insurance premiums that are based on income. Additionally, the ACA expanded the Medicaid program.

The ACA requires providers to insure those with pre-existing conditions, and prohibits them from increasing rates for those with pre-existing conditions as well. It also allows dependents to stay on their parents’ plan until they are 26. To further protect consumers, the ACA requires the disclosure of financial relationships between health entities, including physicians, hospitals, pharmacists, or other providers, and manufacturers and distributors of covered drugs, devices, biologicals, and medical supplies.

The ACA also included a number of tax changes to finance health reform.

The American Health Care Act of 2017 (AHCA), which passed in the House in May of 2017, is a bill intended to “repeal and replace” the ACA. Below is a brief summary with a few of the key changes, as well as important provisions from the ACA that remain.

What Stays The Same

  • AHCA keeps regulations requiring providers to insure those with pre-existing conditions, but allows providers to increase rates for those with pre-existing conditions.
  • The exchanges run by the federal government and states, which listed individual and small business health insurance plans, would continue to function as they would under the ACA.
  • The AHCA would keep the ACA’s requirement that dependents be allowed to stay on their parents’ plan until they are 26.
  • The exchanges run by the federal government and states, which listed individual and small business health insurance plans, would continue to function as they would under the ACA.
  • The AHCA continues to provides premium tax credits based on income, but the formula is for said tax credits is altered in a way that greatly lowers subsidies for young, low-income americans.
  • The AHCA technically repeals the “Individual Mandate,” but replaces it with a surcharge of up to 30% on the next time an individual purchases insurance after a lapse in coverage.

What Would Change

  • The AHCA reverses many of the ACA’s expansions of Medicaid.
  • The ACA’s cost-sharing provisions that lowered costs for some low-income Americans would be eliminated.
  • The AHCA repeals many of the taxes levied by the ACA, replacing them with some new taxes, including a new tax on the value of health insurance paid for by employers.

What This Means For Those With Disabilities

This legislation fundamentally alters Medicaid by shifting the program to a per capita cap system while also reducing protections for those with pre-existing conditions.  States would be able to obtain waivers to allow insurers to charge more for those with pre-existing conditions in some cases, and to forgo the requirement that health plans include what are known as “essential health benefits” like mental and behavioral health treatment as well as rehabilitative and habilitative services and devices. The bill would institute a per capita cap for Medicaid: meaning that the federal government would offer a fixed amount of money for each beneficiary. The Congressional Budget Office has estimated that the plan would lead to $880 billion less in federal spending on Medicaid between 2017 and 2026. Reductions in available funding threatens the continued availability of  home and community based services .

School districts are currently able to seek reimbursement from Medicaid for a variety of services provided to children under the Individuals with Disabilities Education Act. Medicaid reimburses schools for everything from speech and occupational therapy to wheelchairs and specialized playground equipment. Under the AHCA, states would no longer have to consider schools as eligible Medicaid providers, which means that districts would have the same obligation to provide services for students with disabilities under IDEA, but no Medicaid dollars to provide medically-necessary services.

The AHCA will invariably make insurance more expensive for those with disabilities through a variety of mechanisms, including reduced medicaid spending, the cut of pre-existing condition protections, and the exclusion of “essential health benefit” requirements.

 

Status:

The bill was introduced in the House by Congresswoman Diane Black [R-TN-6] in March of 2017. After a series of amendments, the bill passed through the House without a CBO score in May of 2017. A related Senate bill is under discussion and is likely to be returned to the House for a vote.

 

Organizations Against This Bill:

American Association of School Administrators

American Dance Therapy Association

American Federation of Teachers

American Foundation for the Blind

American Occupational Therapy Association

American Psychological Association

Association of Assistive Technology Act Programs

Association of Educational Service Agencies

Association of University Centers on Disabilities

Autistic Self Advocacy Network

Center for Public Representation

Colorado School Medicaid Consortium

Conference of Educational Administrators of Schools and Programs for the Deaf

Council for Exceptional Children

Council of Administrators of Special Education

Council of Parent Attorneys and Advocates

Disability Rights Education & Defense Fund

Division for Early Childhood of the Council for Exceptional Children (DEC)

Healthy Schools Campaign

Higher Education Consortium for Special Education

Judge David L. Bazelon Center for Mental Health Law

LEAnet, a national coalition of local education agencies

Learning Disabilities Association of America

Lutheran Services in America Disability Network

National Association of Pediatric Nurse Practitioners

National Association of School Nurses

National Association of School Psychologists

National Association of Social Workers

National Association of State Directors of Special Education (NASDSE)

National Association of State Head Injury Administrators

National Center for Learning Disabilities

National Association of Councils on Developmental Disabilities

National Disability Rights Network

National Down Syndrome Congress

National Education Association

National Health Law Program

National Respite Coalition

National School Boards Association

Paradigm Healthcare Services

School Social Work Association of America

School-Based Health Alliance

Society for Public Health Education

Teacher Education Division of the Council for Exceptional Children

The Arc of the United States

United Way Worldwide

United Cerebral Palsy

Cosponsors: None.