Summary: The AHCA cuts $1.5 trillion dollars in federal funding over 10 years by slashing state Medicaid (-$830B), eliminating Marketplace subsidies (-$665B) to individuals and families, and causing 23 million Americans to become uninsured over 10 years. The President’s budget cuts $2 trillion dollars in health spending over 10 years, disproportionately affecting low-income, elderly and rural Americans.
The American Health Care Act (AHCA) was passed by the U.S. House of Representatives on May 4, 2017 by a vote of 217 to 213. The Congressional Budget Office posted its costs and coverage estimates of that bill on 05/24/20171. If passed by the Senate then signed by the President, the CBO estimates it would:
- Increase U.S. uninsured by 14 million in year 2018, and 23 million uninsured by year 2026.
- Increase the uninsured total to 51 million Americans by year 2026, versus 28 million who would lack insurance in 2026 under the current Affordable Care Act (ACA) law.
- Decrease by almost $1.5 trillion dollars the federal funding of health coverage over 10 years (2017-2026) by cutting Medicaid funding to states ($830 billion) and eliminating ($665 billion) in marketplace subsidies to help low-income Americans buy health plans (page 39 CBO Report1).
- Disproportionately affect the frail elderly, blind, disabled and rural Medicaid enrollees.
- Cut by $830 billion dollars over 10 years in federal Medicaid funding to states, resulting in 14 million fewer Medicaid enrollees by 2026.
- Reduce by $665 billion dollars over 10 years in federal subsidies to help individuals buy health insurance (also known as the nongroup or individual health insurance market) by eliminating in year 2020 the ACA’s refundable tax credits and cost sharing reductions. These would be replaced by $275 billion in tax credits for nongroup insurance in year 2020.
- Allow insurers in 2018 to charge older enrollers five times more than younger enrollees, versus three times more under current law.
- Allow insurers to impose a 30% charge to individuals who did not maintain continuous coverage.
- Allow states to waive the Affordable Care Act’s consumer protections and thereby stop requiring insurers to include the 10 essential health benefits (such as preventive services, newborn care, and maternity coverage), and allow insurers to go back to charging people more for pre-existing conditions (eliminates the community rating) if a person had not maintained continuous coverage.
- Appropriate $8 billion dollars per year in 2018 in funding for states that obtain a waiver for a Patient and State Stability Fund starting in 2018 for those with pre-existing conditions.
- Provide $15 billion in funding to states choosing to waive the ACA requirements for community rating and essential health benefits for maternity coverage, newborn care, prevention, treatment, or recovery services for people with mental and/or substance use disorders.
- $610 billion in federal Medicaid funding to states. It is not clear how this relates to AHCA cuts.
- $193 billion for the Supplemental Nutrition Assistance Program (SNAP, aka food stamps).
- $72 billion in Supplemental Security Income (SSI) disability.
- $21 billion in Temporary Aid to Needy Families (TANF).
- $87 billion for the National Institutes of Health
- $18 billion for the Centers for Disease Control and Prevention