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- 1 How You Can Resist
- 2 Recent Updates
- 3 Impact of American Health Care Act (Part II)
- 4 Impacts of the ACA
- 5 Affordable Care Act
- 6 CHIP
- 7 The State of Public Health
How You Can Resist
- Call your member of Congress by dialing tel:844-6-RESIST and tell them to strengthen the Affordable Care Act.
- Find out when your Senators and US Representative are holding town halls and other Upcoming Events/Opportunities. Show up and tell them to strengthen the Affordable Care Act.
- Click here to find an organization looking for volunteers.
- 4/23/2017: The White House wants vote on repealing Obamacare as soon as possible. As the President's first 100 days expire, he's facing enormous pressure to gain ground in dismantling Obamacare. Multiple Republican sources have said that they're not sure they have the 216 votes needed to pass an already unpopular bill.
- 4/20/2017: Moderates and hardline conservatives, who have disagreed on the AHCA since it was introduced, have found middle ground through the addition of the MacArthur Amendment. This amendment will reinstate Essential Health Benefits as the federal standard and maintain many provisions of the AHCA, such as prohibitions on discrimination based on gender and pre-existing conditions. The amendment also allows states to obtain limited waivers for Essential Health Benefits and Community Rating Rules. States must be able to prove that the purpose of the waiver is to reduce premium cost, increase health coverage, or advance another benefit of health coverage. 
Impact of American Health Care Act (Part II)
What is the American Health Care Act?
The American Health Care Act (AHCA) is the Republican proposal to repeal and replace the Affordable Care Act (ACA), also known as Obamacare. The original version of this plan was first announced on March 6, 2017. The AHCA would keep some popular parts of the ACA, like the ban on charging more for preexisting conditions and allowing young adults to stay on their parents’ plan until they are 26. The ACHA would end Obamacare's “individual mandate," the tax on those who don’t purchase health coverage. The AHCA would provide lower subsidies for those who buy coverage on the individual market and phase out the Medicaid expansion starting in 2020. It also includes tax cuts that benefit the wealthy. On March 13, 2017, the Congressional Budget Office estimated that this plan would would cause 24 million Americans to lose coverage by 2026. House Republicans were unable to get enough support for a vote for the original version of the bill and withdrew it on March 24, 2017.
Both moderate and far-right House Republicans opposed the original bill, and the two groups have been negotiating changes to the AHCA. AHCA II refers to the original plan with the addition of the MacArthur Amendment, which would allow states to opt out of some ACA requirements.
Where the AHCA II Stands
- Aides say there are no plans for a vote the week of April 24, 2017, and no text of the bill was available to members of Congress while they were out on holiday recess.
- Congress also has to focus on funding the government; this funding runs out on April 28, Trump's 99th day in office.
- The amendment to the bill is designed to bridge the gap between moderates and conservatives who rejected the last bill for different reasons.
The MacArthur Amendment and Its Impact
This amendment to the AHCA and all other amendments in the House work by being submitted to the Rules Committee which then determines whether the amendment is relevant to the actual bill. Then the bill goes to the House floor for debate. 
- Reinstates Obamacare essential health benefits
- Prohibits denial of coverage due to preexisting conditions
- Covers dependents on their parents' plan up to age 26
- Allows states to seek limited waivers on what's called Essential Health Benefits and Community rating rules—though rules on age, health, and gender cannot be waived
- States that waive (choose not to require) these rules would leave sicker people with higher costs, pushing them into costly high-risk pools. More than 130 million non-elderly Americans have preexisting conditions, and the return of rating people based on health status could leave the average person spending thousands more on health insurance. If a state files this waiver, it will be easier for insurers to discriminate.
- The average surcharge for several health conditions can be seen here.
- Larry Levitt, who works at a health policy research foundation, thinks that the AHCA will ultimately remove protections for people with preexisting conditions. He said, “No insurance company will want to cover people with expensive health conditions if they don’t have to, so they will set premiums to make sure the coverage is out of reach."
- The new plan still aims to cut Medicaid by turning it into a block grant program, which will result in 14 million fewer people on Medicaid, according to the Congressional Budget Office. This means that the federal government will give states a fixed amount of money for Medicaid rather than reimbursing states for the guaranteed coverage they provide.  
- Rep. Charlie Dent, R-Penn., a moderate, says that these changes aren't enough to change his mind: "'It doesn't do anything to change the problems with the underlying bill,' Dent said, adding that he's still concerned about the cuts to Medicaid and that the tax credits aren't generous enough to help the low-income and seniors."
- The plan doesn't address other conservatives' concerns, including eliminating the mandate on pre-existing conditions and other insurance rules they see as harmful. The plan also doesn't address the concerns of moderates who are worried about cuts to Medicaid and tax benefits that are too small to help people purchase individual coverage. 
Impacts of the ACA
Insurance Coverage by Congressional District
- The number of those who gained coverage through ACA exchanges and the Medicaid expansion
- The number of those who still remain uninsured
Preexisting Conditions by Congressional District
- The number of people with preexisting conditions
Benefits of the ACA
- About 20 million people gained insurance.
- This is largely the result of expanding Medicaid, the federal insurance program for people with low incomes. The Medicaid expansion is currently under threat.
- The uninsured population of the US went from 16% in 2010 to 9% in 2015.
- 15.7 million people gained access to Medicaid.
Criticisms of the ACA
- The law mandates that all Americans have health care. If you do not, you pay a tax penalty. Some see this as a curtailment on individual liberties. The reasoning is that if only sick people buy health insurance, premiums (how much you pay for coverage) will skyrocket, as insurance companies try to make enough money to pay everyone's health care bills. If everyone, including healthy people, buys insurance, premiums will be more stable.
- The federal government is funding the Medicaid expansion for those newly eligible for coverage until 2020. After 2020, the federal government will only pay 90%, so states will be responsible for the rest. There is still a significant coverage gap for people who can't receive Medicaid (see above) or exchange subsidies.
- For many people who buy insurance on the exchanges, deductibles (the amount you have to pay yourself for your coverage before your insurance company starts paying) has increased significantly.
- Because of the new requirements on insurance companies, some insurance companies canceled plans that did not comply with the law, forcing people to buy plans over the exchanges. Some workplaces also stopped providing insurance to their employees.
- Some say that the law discourages healthy people from purchasing health care, which increases premiums for those who do have health care—because they are less healthy, so insurance companies must charge more so they can make sure they can cover everyone. Premiums have definitely increased, but not for most people purchasing through the exchanges, since subsidies have also increased.
- Many large insurers are beginning to stop offering health insurance plans over the exchanges. This limits choices for people who must buy insurance over the exchanges.
- While there were concerns in previous years that some counties would be left without an insurer, it hasn’t yet happened. Some exchanges under duress in several states like Tennessee, where 16 counties don’t have any insurers lined up to sell on the marketplaces for 2018. The fate of the markets in those counties and a few other states depends on what Republicans in Congress do next.
- Trump has said that the ACA is "exploding," meaning mostly that premium costs are going to rapidly increase, leading to a "death spiral," in which healthy people prefer to pay the penalty rather than pay for health care. This would make premiums increase even more, making more people opt out. This has not started to happen so far, and there is no good evidence that it will.
- Some say the law does not go far enough. Millions of Americans still do not have health care, and health care purchased through the exchanges is often too expensive or does not provide high quality care. Health care is still very corporate in the US, with businesses (insurance companies) making too many health care decisions for people.
Affordable Care Act
The Patient Protection and Affordable Care Act, usually called the Affordable Care Act or Obamacare (they are the exact same thing), is a law passed in 2010 and signed by President Obama to increase access to health care in the US. The law includes three major parts: 1) new regulations on private insurance companies that apply to employer-provided health care plans 2) a Medicaid expansion, which gave millions more people access to free government health care and 3) state health-care exchanges, which let people buy their own health insurance.
People Receiving Health Care from Employers
The law also changed some of the ways insurance companies operate. Insurance companies are no longer allowed to refuse to cover people or charge them more if they have "preexisting conditions," meaning that if you have diabetes, for example, an insurance company cannot refuse to give you insurance for only that reason. Insurance companies also cannot have annual or lifetime limits on coverage, meaning they may not stop covering someone once a certain dollar limit had been reached. Premiums—how much people pay for insurance—is now much more even, as insurance companies cannot increase the price for people who will have more expensive health care needs.
People Receiving Health Care from Medicaid/Medicare
The law increased Medicaid eligibility to those who earn 138% of the federal poverty limit. 15.7 million people gained Medicaid under the ACA. As of September, though, 19 states had not actually expanded Medicaid in their states, so not everyone who is eligible under the ACA actually has Medicaid. Such people are also not eligible for subsidies through the exchanges, because they are supposed to have Medicaid, so they are actually left without health care, in a "coverage gap."
People Purchasing Health Care Privately
Through the exchanges, which are organized by state, people who do not have another source of health care (through work, Medicare, or Medicaid, usually) can buy health care. Subsidies are available to people earning less than 400% of the federal poverty level, lowering the amount they have to pay.
The Children's Health Insurance Program (CHIP) provides health coverage to eligible children, through both Medicaid and separate CHIP programs. CHIP is administered by states, according to federal requirements. The program is funded jointly by states and the federal government.
For more information about eligibility and applying for CHIP, please follow the link.
The State of Public Health
National Institutes of Health
- The Trump Administration has proposed a 1.6 billion cut to the NIH including :
- Take $350 million from the National Science Foundation's budget
- Cut $37 million from the Department of Energy's budget which allocates to significant science programs
- Cut $48 million from the Environmental Protection Agency's research and development budget.
- Cut in half the $101 million Teen Pregnancy Prevention program
- Reduce Food and Drug Administration staff spending by $40 million
- Cut domestic and global HIV/AIDS programs by $100 million
- And cut the Presidential Emergency Program for AIDS Relief (PEPFAR) by $242 million
- Completely delete the $72 million Global Health Security fund at the State Department and cut other global health programs by $90 million and $62 million for global family planning
- The Trump Administration has changed the timetable for some visa applications through the use of the travel ban. Since it is being challenged in court, the decision will probably delay the arrival of new foreign doctors.
- The U.S. Citizenship and Immigration Services has temporarily suspended the “premium processing” option by which employers could pay an extra $1,225 to have H-1B applications approved in as little as two weeks, rather than several months. 
- This has slowed, and will continue to slow the flow of foreign doctors who need to fill a need in a short time period. This is starting to have huge effects on rural communities who may depend on foreign doctors to provide treatment.