By Claire Vernon, PhD
Last week the US House turned its sights back to healthcare legislation and passed an amended version of the American Health Care Act, the Republican party’s ‘repeal and replace’ of Obama’s Affordable Care Act. While it remains to be seen how this legislation survives in the Senate, many groups have weighed in on what is widely seen as a step backwards for ensuring access to care for all Americans. Among them, the American Medical Association, the American Public Health Association, the National Partnership for Women and Families, and AARP have released statements opposing the anticipated loss of coverage for people with preexisting conditions, expensive medical needs, lower income, or greater age.
Timothy Jost wrote a great breakdown of how the AHCA differs from the ACA on the Health Affairs blog. Although many elements of the ACA would be kept in place by the AHCA, changes effectively cripple the preserved mandate that insurers extend coverage to everyone: subsidy support for lower-income individuals’ premiums would be lost, premiums for older individuals would be allowed to be 5-times higher than for young people, and insurers could consider a person’s health risk when offering coverage if that person let their previous coverage lapse. Linda Blumberg and John Holahan at the Health Affairs Blog discussed the measures that need to be in place for preexisting condition exclusions to be effectively prohibited ahead of the bill being passed last week. Key among those are that insurers must be required to cover Essential Health Benefits, such as pregnancy or mental health care, and that cost-sharing standards should be sufficient to protect high-risk individuals rather than relying on high-risk pools. While penalizing people for preexisting conditions would be unfortunate, the waivers on Essential Health Benefits mean a much larger swath of Americans could be negatively affected by the AHCA, including those with employer-provided plans. In its current state, the AHCA would allow states to apply for waivers to Essential Health Benefits requirements, establishing a fund for high-risk pools. Additionally, it phases out the ACA’s Medicaid expansion and prevents Medicaid payments to Planned Parenthood for a year.
After the House passed the AHCA, people took to Twitter with #IAmAPreexistingCondition to highlight how common pre-existing conditions are. The AP discussed two conditions that were commonly mentioned in the Twitter exchange, pregnancy and rape, noting that coverage denial for existing pregnancies was common prior to the passage of the ACA and that while being a victim of rape would not technically a preexisting condition, mental or physical health challenges resulting from such an attack could be.
Ultimately, the goal should be two-fold: to find a sustainable way to ensure access to health care to Americans, and to ensure that both individual and employer-provided health coverage constitute worthwhile plans that provide meaningful care. Margaret Murray and Mike Adelberg argue that there are lessons to be learned from the struggles and successes of the ACA’s Marketplaces, and the importance of these lessons only increases as current policies unfold.
AMA Wire. https://wire.ama-assn.org/ama-news/physicians-reject-house-aca-replacement-bill and https://wire.ama-assn.org/ama-news/flawed-ahca-passes-house-despite-outcry-physicians-patients Posted March 8, 2017 and May 4, 2017. Accessed May 8, 2017.
 APHA News & Media. https://www.apha.org/news-and-media/news-releases/apha-news-releases/2017/house-passage-of-ahca Posted May 4, 2017. Accessed May 8, 2017.
 National Partnership for Women & Families. http://www.nationalpartnership.org/news-room/press-releases/house-passage-of-the-american-health-care-act-a-callous-move-that-imperils-womens-health-and-economic-security-ness-says-noting-that-trumps-best-day-so-far-is-americas-worst.html Posted May 4, 2017. Accessed May 8, 2017.
 AARP Advocacy. http://www.aarp.org/politics-society/advocacy/info-2017/aarp-opposes-healthcare-bill.html and http://www.aarp.org/politics-society/advocacy/info-2017/congress-seeks-to-revive-health-care-bill-fd.html?intcmp=AE-POL-ADVO-FFH-ART_SL1-FD_041017_ReviveHCB Posted March 7, 2017 and April 25, 2017. Accessed May 8, 2017.
 Health Affairs Blog. Following the ACA: House Passes AHCA. http://healthaffairs.org/blog/2017/05/04/house-passes-ahca-how-it-happened-what-it-would-do-and-its-uncertain-senate-future/ Posted May 4, 2017. Accessed May 8, 2017.
 Health Affairs Blog. Following the ACA: Making a Prohibition on Preexisting Conditions Effective. http://healthaffairs.org/blog/2017/05/02/making-a-prohibition-on-preexisting-condition-exclusions-effective-requires-additional-measures/ Posted May 2, 2017. Accessed May 8, 2017.
 Brookings Institute. Matthew Fielder. https://www.brookings.edu/2017/05/02/allowing-states-to-define-essential-health-benefits-could-weaken-aca-protections-against-catastrophic-costs-for-people-with-employer-coverage-nationwide/ Posted May 2, 2017. Accessed May 9, 2017.
Kaiser Health News. Morning Briefing May 9, 2017. http://khn.org/morning-breakout/beyond-preexisting-conditions-gops-change-to-essential-benefits-would-affect-nearly-everyone/ Posted May 9, 2017. Accessed May 9, 2017.
 The AP Newswire. http://hosted.ap.org/dynamic/stories/U/US_PREGNANCY_PRE_EXISTING_CONDITIONS_FACT_CHECK?SITE=AP&SECTION=HOME&TEMPLATE=DEFAULT&CTIME=2017-05-05-16-08-51 Posted May 5, 2017. Accessed May 8, 2017.
 Health Affairs Blog. Following the ACA: The ‘Medicaidization’ of the Health Insurance Marketplaces. http://healthaffairs.org/blog/2017/05/08/the-medicaidization-of-the-health-insurance-marketplaces-a-necessary-trend/ Posted May 8, 2017. Accessed May 9, 2017.
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