On March 6, Paul Ryan and the House Republican leadership released a proposed healthcare plan entitled the American Health Care Act. The plan was put forward as a replacement for the Affordable Care Act or “Obamacare,” and changes major pieces of the healthcare system.
The nonpartisan Congressional Budget Office estimates that it would decrease the federal deficit by 337 billion over the next decade, while increasing the number of uninsured by 24 million over the same period. Many of the AHCA’s proposed changes will directly affect people with disabilities, especially individuals receiving healthcare subsidies and those enrolled in Medicaid.
Some of the most relevant changes include:
• The AHCA will replace income-based federal healthcare subsidies with fixed tax-credits based on age. This is likely to have a disproportionate effect on the affordability of health coverage for low-income individuals.
• Federal Medicaid funding would be distributed to states on a per-capita system, based on the number of state Medicaid enrollees rather than actual costs of coverage. As disabled Americans tend to have higher health care costs, states would be forced to either cover the costs in excess of federal funding on their own, or find ways to reduce costs.
• Starting in 2020, the AHCA would no longer require Medicaid to provide a minimum of “essential health benefits.” A number of those benefits, including preventative care and chronic disease management, are of vital importance to people with disabilities. The elimination of base healthcare requirements, along with cost-cutting and federal funding caps, have many disability-rights advocates worried that the AHCA will reduce the quality of Medicaid coverage.
• The AHCA discontinues federal funding for two programs, Money Follows the Person and Community First Choice, which support independent living for disabled and elderly people who need professional care services [see The Affordable Care Act Supports Independent Living].
The proposed AHCA legislation has faced strong opposition from a broad coalition of groups including Democrats, conservative Republicans, health care provider organizations, the AARP, and disability-rights organizations.
“For people with disabilities, healthcare is a lifeline,” says Alexandra Bennewith, vice president of government relations at the United Spinal Association. “Not only to our personal health, but a lifeline to our education, to our employment and to our contributions to our communities and our country. That lifeline was significantly strengthened by Obamacare. But the American Health Care Act is threatening that lifeline.”
The Republican leadership is currently scrambling to make changes to the legislation to whip up enough votes for it to pass a planned March 23 vote in the House. None of the latest proposals would affect the core AHCA tenets outlined above.