The House Budget Committee voted 19-17 to advance the American Health Care Act, the Affordable Care Act replacement proposal, on to the House Rules Committee Thursday. The close vote was the result of three GOP defections from the Republican plan.
Representatives Gary Palmer, R-Ala., Mark Sanford, R-S.C., and Dave Brat, R-Va., all opposed the AHCA because the proposal allegedly did not adequately repeal the ACA. Along with Palmer, Sanford, and Brat, the top-ranking Democrat on the budget committee—John Yarmuth of Kentucky—also opposed the bill, saying that if the AHCA were enacted, it would cause millions of Americans to lose their coverage and affect their access to care.
“This bill and future legislation and rule-making will put insurance companies back in charge,” Yarmuth said. “[This allows] them to once again to decide who lives and who dies.”
Meanwhile, House Budget Chairwoman Rep. Diane Black, R-Tenn., supported the legislation. She said, “We made a promise to the American people to repeal this law and replace it with patient-centered health care reforms, where Americans can have the health insurance they want and need at a price they can afford. This bill is a good first step.”
Although the AHCA advanced through the budget committee, the proposed Obamacare repeal-and-replacement measure will not pass the House if all members of the conservative Freedom Caucus and all Democrats oppose it. Modern Healthcare reports the AHCA currently is facing issues in the Senate, where “many moderate Republicans have voiced concern that it would rescind Medicaid expansion.” Specifically, four Republican senators from Medicaid-expanded states said “they did not support a previous version of the House bill, because it didn’t adequately protect people who’ve gained coverage through the expansion,” according to Modern Healthcare.
But Darshan Gandhi, medical director of oncology services at Methodist Charleston Hospital and board advisory board member of the Texas Health and Human Services Commission, says that with the House budget committee pushing the AHCA on to the House Rules Committee—albeit by a slim margin—the contentious bill seems to be moving closer to reality.
“Although the Congressional Budget Office and Joint Committee on Taxation predict an eventual decline in the deficit by approximately $337 billion [if the bill becomes law], it would come at a cost of more than 24 million patients across the nation losing their insurance,” Gandhi said.
So, what does this mean for Texas? Gandhi says that even though the ACA was controversial, it helped reduce the number of uninsured Texans by more than 1.7 million, dropping the state’s uninsured percentage from 25 percent to 16.8 percent.
Gandhi says predictions show that if the AHCA is enacted, more than 900,000 Texans might end up losing this newly acquired benefit. The impact would be felt most by the state’s low-income population, which tends to be the sickest and most in need of care.
“Hospitals and clinics that had opened their doors to millions of patients may start reversing the process,” Ghandi said. In addition, “Dallas county has been ranked among the highest uninsured counties in the country. The healthcare provider community hopes that the bill would be amended to alleviate some of these concerns, before it reaches the Senate for a vote.”
From the payor perspective, Dr. Shyama Gandhi, medical director at Molina Healthcare of Texas, says that if the AHCA actually went into effect in 2020, the ACA’s financial assistance to consumers would be replaced by age-based tax credits.
“It would be critical to see how the tax credits will play out, and how [they] will affect the pool of individuals who will choose to buy insurance,” she said. “The fear is that while sicker individuals would continue to buy insurance, the healthy would wait until they are actually sick and in need of insurance. This change in the consumer pool might lead payers to either hike the premiums. making plans less affordable, or leave the market altogether.”