Vote on the American Heath Care Act Postponed

Dear Catherine,

The American Health Care Act (AHCA) was introduced in the U. S. House of Representatives on March 6 and for a second day in a row, it was not brought to a vote due to a lack of enough support for passage. The AHCA was introduced in an effort to repeal and replace the Patient Protection and Affordable Care Act (ACA or "Obamacare"). The bill was championed by House Speaker Paul Ryan and President Donald Trump, but was hotly debated by both Democrats and Republicans.
 

The priorities of the Cancer Support Community (CSC) are access, coverage, affordability, and equity for patients living with chronic illnesses such as cancer. People impacted by cancer were concerned about the potential impact of the AHCA, particularly the following provisions:
 

Changes to the Individual and Employer Mandate: There would be no requirement to purchase insurance coverage, however individuals would have been encouraged to maintain coverage by allowing insurers to charge 30% more if there was a gap in coverage that lasted longer than 63 days. If someone was unable to afford to purchase and maintain individual coverage, this penalty could make it very difficult to ever enter the insurance market.

Changes to Medicaid: The expansion of Medicaid under the ACA that covered unprecedented numbers of individuals would have eventually been repealed. States would no longer have been allowed to cover adults with incomes over 133 percent of the federal poverty level. States could have imposed work requirements for some Medicaid beneficiaries and states could have received a lump-sum block grant rather than per capita funding. These changes could have potentially limited health insurance coverage and access to care for the most vulnerable individuals.

The Elimination of Subsidies: The current system of subsidies, which have helped individuals with low or moderate incomes afford health insurance, would have been replaced with a tax credit for patients to utilize on the individual health market. This tax credit was based on age and income and would have meant that some patients would not receive as much assistance to pay for their health care costs. Subsidies to help individuals cover out-of-pocket costs such as deductibles and co-payments would have also been eliminated.

Increased Costs for Older Americans: The current system allows insurers to charge their oldest enrollees three times as much as younger enrollees. This would have changed and seniors could have been charged up to five times as much as younger enrollees per the American Health Care Act.

The Elimination of Essential Health Benefits: EHBs were required under the Affordable Care Act (ACA) and would have been repealed by the AHCA. These include cancer screenings, hospitalizations, prescription medications, maternity care, and mental and behavioral health treatment, among other services. Instead, states would have been able to determine the basic health benefits that insurance covers. There would have been no minimum coverage requirements which meant that plans could offer far less comprehensive insurance coverage and patients would  have paid more out-of-pocket for services they might need.

Reliance on Health Savings Accounts: The AHCA would have allowed individuals to contribute more money to Health Savings Accounts (HSAs), which allow people to contribute pre-tax dollars to pay for out-of-pocket expenses. HSAs are an option for people who have incomes high enough that they are able to contribute to the accounts. However, people with low- or moderate-incomes may not be able to afford to contribute to HSAs.

CSC was concerned about the burden these proposed changes would place on individuals living with cancer and people who have historically been underserved by the health care system. We do not want to see costs shifted to consumers, particularly among cancer patients who often need expensive treatments and services. We do not want health care access to become limited because programs like Medicaid become more restrictive. We are concerned that optional health savings accounts will exclude individuals who cannot afford to contribute funds to them to cover the cost of health care.

We look forward to keeping you posted on health care reform and any policy issues that have the potential to impact cancer patients and their families. 

Sincerely,

Elizabeth Franklin & Kristen Cox Santiago

Senior Directors, Policy & Advocacy

Cancer Support Community