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== [[File:fist.png | left | 50px | How You Can Resist | link= ]] How You Can Resist ==
 
== [[File:fist.png | left | 50px | How You Can Resist | link= ]] How You Can Resist ==
*'''Call your member of Congress''' by dialing tel:844-6-RESIST and tell them to strengthen the Affordable Care Act.
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*'''Call your Senator''' by dialing tel:844-6-RESIST and tell them to oppose Trumpcare.
*'''Find out when''' your Senators and US Representative are holding '''[https://townhallproject.com/ town halls]''' and other [[Upcoming Events/Opportunities]]. Show up and tell them to strengthen the Affordable Care Act.
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*'''Find out when''' your Senators are holding '''[https://townhallproject.com/ town halls]''' and other [[Upcoming Events/Opportunities]]. Show up and tell them to oppose Trumpcare.
*Click [https://www.resistancemanual.org/People_and_Organizations here] to find an organization looking for volunteers.
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*'''Call your Representative''' by dialing tel:844-6-RESIST and tell them how you feel about their vote on repealing the Affordable Care Act. See the complete list of how each representative voted [https://www.nytimes.com/interactive/2017/05/04/us/politics/house-vote-republican-health-care-bill.html/ here].
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*Find health-care organizations with [[Organizations_Working_for_Justice_and_Equity#Health_Care|volunteer opportunities]], with nationwide [[Organizations_Working_for_Justice_and_Equity#Health_Care_2|networks of groups]], and with [[Organizations_Working_for_Justice_and_Equity#Health_Care_3|information and opportunities for online activism]].
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*Visit [https://trumpcaretoolkit.org/ Trumpcare Toolkit] and [https://www.trumpcareten.org/ Trumpcare Ten] to contact senators who could provide the deciding votes against Trumpcare. See [https://www.ouramendments.org/ Our Amendments] to submit an amendment to Trumpcare, which could slow down the process of passing the bill. See how your senator is planning to vote [http://thehill.com/homenews/senate/338996-the-hills-whip-list-senate-obamacare-repeal-bill here].
  
 
== [[File:notification.png | left | 50px | Updates | link= ]] Recent Updates ==
 
== [[File:notification.png | left | 50px | Updates | link= ]] Recent Updates ==
*'''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. [http://www.politico.com/f/?id=0000015b-8ab0-df96-a9db-dff115c30001]
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*'''7/25/17''' The Senate voted to open debates on a bill to repeal major parts of the Affordable Care Act (ACA). However hours later, the Republican Senate failed to receive the 60 votes needed to pass their most detailed plan to replace the ACA. The Senate is now moving ahead with debate, amendments (changes) and a final vote in the coming days on legislation. If passed, the bill would have big effect on the American health care system which accounts for almost one-sixth of the United States’ economy.[https://www.nytimes.com/2017/07/25/us/politics/senate-health-care.html?hp&action=click&pgtype=Homepage&clickSource=story-heading&module=a-lede-package-region&region=top-news&WT.nav=top-news]
*'''4/14/2017:''' The Trump Administration has threatened to withhold $7 billion in cost sharing subsidies from insurers, if Democrats refuse to join healthcare talks. Democrats have promised to torpedo any bill that doesn't allocate this money as mandatory spending. [http://www.politico.com/story/2017/04/donald-trump-obamacare-subsidies-negotiate-237174]
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*''' 7/16/17''' The Congressional Budget Office postponed release of an analysis on the latest GOP healthcare bill. They did not give an explanation or an estimate when the analysis was expected. [http://www.latimes.com/politics/washington/la-na-essential-washington-updates-cbo-delays-analysis-of-the-latest-1500307330-htmlstory.html]  
*'''4/13/2017:''' The Trump Administration released a rule on Thursday aimed at keeping insurers in the ObamaCare marketplace. It's a sign that the Trump administration will try to keep the marketplace stable while Congress works on repealing and replacing the healthcare law. Critics have said that it wil ake it harder for any people to get insurance [http://thehill.com/policy/healthcare/328751-trump-administration-moves-to-stabilize-obamacare-markets]
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* '''7/16/17''' The Senate vote on the healthcare bill was delayed due to the absence of Senator John McCain, who is recovering from surgery. The vote is predicted to be close.[http://www.washingtonpost.com/powerpost/gop-opponents-to-senate-health-care-bill-see-vote-delay-as-an-advantage/2017/07/16/3e5516fa-6a21-11e7-96ab-5f38140b38cc_story.html?utm_term=.0b990a3c89af]
*'''4/12/2017:''' House Freedom Caucus Chairman Marl Meadows has suggested the possibility of Congress cutting their recess short to vote on an Obamacare repeal. Speaker Ryan has reportedly not ruled it out. [https://twitter.com/elizacollins1/status/851783431977656321]
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* '''7/14/17''' Two GOP senators have indicated that they oppose the healthcare bill, and 11 others have expressed concerns with some form of the bill. The bill will not pass if there are 3 Republican votes against it.[https://www.washingtonpost.com/graphics/2017/politics/ahca-senate-whip-count/?utm_term=.674472275241]
*'''4/12/2017:''' President Donald Trump says he still wants Congress to pass a health care bill before turning to tax reform - an apparent reversal from last month, when he said he was ready to move on to overhauling the nation's tax code after the repeal bill collapsed. [http://www.politico.com/story/2017/04/trump-tax-reform-health-care-237125]
 
*'''4/11/2017:'''President Trump is set to nominate 3rd Term Congressman Tom Marino (R-PA) to the Office of National Drug Control Policy, as the nation's unofficial Drug Czar. [http://www.cbsnews.com/news/pennsylvania-congressman-to-be-named-drug-czar-by-donald-trump/]
 
  
== [[File:notification.png | left | 50px | Impact of Trumpcare Part Two | link= ]] Impact of Trumpcare Part Two==
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*'''6/29/2017''' A new CBO score analysis says that the Republican plan to change how Medicaid payments are calculated has a deeper impact thn previously thought. The new analysis says that the government would spend 35 percent less on Medicaid than under the current law, compared with a 26 percent decrease in the first decade. [https://www.washingtonpost.com/powerpost/gop-health-care-debate-turns-to-stark-question-help-vulnerable-americans-or-help-the-rich/2017/06/29/02d96318-5cd1-11e7-9fc6-c7ef4bc58d13_story.html?tid=ss_tw&utm_term=.04d113e0533d]
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*'''6/28/2017''' Senate Majority Leader McConnell has announced that the vote on the Better Care Reconcilliation Act will be delayed until after the July 4th recess due to growing opposition among Senate Republicans. [https://www.nytimes.com/2017/06/27/us/politics/republicans-struggle-to-marshal-votes-for-health-care-bill.html?_r=0]
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*'''6/22/2017''' Senate Republicans have released a "discussion draft" of their bill to repeal and replace Obamacare. A vote is planned for before the July 4th recess. [https://www.budget.senate.gov/imo/media/doc/SENATEHEALTHCARE.pdf] [http://www.nbcnews.com/politics/congress/read-senate-health-care-bill-here-n775461?cid=sm_npd_nn_tw_ma]
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*'''6/18/2017''' Senate Democrats are considering shutting down the Senate in an attempt to force GOP to show their healthcare repeal bill. This bill is being negotiated in secret among some Republicans. To do this, they may:
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**hold the Senate floor for a long period;
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**refuse to hold committee meetings; or
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**refuse to allow routine business in the Senate.[http://www.politico.com/story/2017/06/17/gop-obamacare-repeal-democrat-strategy-239668]
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*'''6/10/2017''' The Trump Administration is showing signs of delaying the payments of Obamacare cost-sharing subsidies. These funds are critical to keep insurance companies on Obamacare exchanges. The White House has also signaled that Congress may need to appropriate funds in the event they decide not to fund it. Meanwhile Obamacare deserts are continuing to spread. [http://www.politico.com/story/2017/05/22/white-house-to-seek-90-day-delay-in-obamacare-subsidy-suit-238674]
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*'''6/06/2017''' Budget reconciliation, also called simply “reconciliation,” lets the Senate majority pass legislation with 50 votes, instead of the usual 60. [https://www.indivisibleguide.com/resource/legislative-process-budget-reconciliation/] The health care bill passed by the House complies with the Senate’s reconciliation process, which means it will only take 50 votes to pass the Senate version. [https://www.budget.senate.gov/chairman/newsroom/press/house-health-care-bill-text-complies_with-senate-reconciliation-process]
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*'''6/05/2017''' Senate Majority Leader Mitch McConnell hopes to send a private draft bill of the the Senate's AHCA to the Congressional Budget Office this week. [https://twitter.com/topherspiro/status/871732178148872193]
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*'''6/05/2017''' The Senate hopes to bring an Obamacare repeal bill to a vote. Many Republicans are pessimistic about getting to the 50 vote threshold, because a consensus has been hard to come to. Prominent Republican Senator Cornyn says that the Senate bill mirror about 80% of the AHCA. [http://www.washingtonexaminer.com/senate-works-to-pass-obamacare-repeal-bill-before-august-recess/article/2624729] [http://thehill.com/homenews/senate/335353-gop-leader-tempers-obamacare-expectations]
  
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== [[File:notification.png | left | 50px | What We Know About the Latest Proposed Senate Healthcare Bill | link= ]] What We Know About the Senate Healthcare Bill==
  
== [[File:notification.png | left | 50px | Threats to the ACA | link= ]] Additional Threats to the ACA by the GOP==
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Senate Republicans plan to draft variations of a bill behind closed doors and releasing the draft right before it comes up for a vote, planned for the end of July. The Senate has also proposed an option to repeal with no replacement. On July 25th, only two Republicans, Susan Collins of Maine and Lisa Murkowski of Alaska, voted against the motion to debate, though at least several other Republicans had been expected to potentially vote against as well. No Democrats voted in favor to debate a Republican replacement bill.[https://www.nytimes.com/2017/07/25/us/politics/senate-health-care.html?hp&action=click&pgtype=Homepage&clickSource=story-heading&module=span-ab-top-region&region=top-news&WT.nav=top-news]
===Health and Human Services Policy and Rule Changes===
 
====Changes to Look Out For====
 
'''Essential Health Benefits'''   
 
*An ACA statute lays out 10 essential health benefits that are required of each insurance plan. It is up to the Health Secretary to design how it's implemented.
 
**The Obama administration largely let states decide what those essential benefits would be, but current Secretary Price could make those decisions at the federal level, requiring insurers to cover fewer services.[http://www.politico.com/magazine/story/2017/03/will-obamacare-really-explode-214949]
 
'''Threats to Marketplaces'''
 
*The Health Secretary could drop a court case [https://ecf.dcd.uscourts.gov/cgi-bin/show_public_doc?2014cv1967-73] '''(U.S. House of Representatives v. Burwell, 2016)'''left over from the Obama administration, a move that would cut some subsidies to more than half of marketplace enrollees. [https://fivethirtyeight.com/features/the-future-of-obamacare-is-in-trumps-hands/?ex_cid=538fb]
 
*The Health Secretary could also loosen a mandate requiring most people to have coverage or pay a penalty at tax time. [https://fivethirtyeight.com/features/the-future-of-obamacare-is-in-trumps-hands/?ex_cid=538fb]. The administration is pretty free to exempt large groups of people from the individual mandate via "hardship exemptions."
 
**More people under these circumstances could be approved for hardships or fewer. If the administration approves more waivers, it could reduce the number of people in the marketplaces. Because of this, healthy people may start to leave in larger numbers, thus creating high-risk pools, which creates more costly coverage causing more people to drop out. [http://www.npr.org/sections/health-shots/2017/03/29/521713002/6-changes-the-trump-administration-can-still-make-to-obamacare]
 
  
'''Threats to Medicaid Rules'''
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The June 25th vote was on a detailed update (amendment) meant to please conservatives and moderates in the Republican caucus. One proposal, offered by Senator Ted Cruz, Republican of Texas, would have allowed insurers to sell stripped-down "skinny" health plans, without maternity care or other benefits required by the Affordable Care Act, if they also sold plans that included such benefits. The amendment also included money to help pay out-of-pocket medical costs for low-income people, including those who buy private insurance after losing Medicaid coverage as a result of the Senate bill. This proposal was written by Senator Rob Portman, Republican of Ohio, and other senators from states that have expanded Medicaid under the Affordable Care Act.[https://www.nytimes.com/2017/07/25/us/politics/senate-health-care.html?hp&action=click&pgtype=Homepage&clickSource=story-heading&module=span-ab-top-region&region=top-news&WT.nav=top-news]
*The Trump appointed CMS (Centers for Medicare and Medicaid Services) Administrator, Seema Verma, has the power to oversee the shape and structure of state run Medicaid programs.[https://www.theatlantic.com/politics/archive/2017/03/the-aca-isnt-out-of-the-woods-yet/520830/?utm_source=twb]
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]
**The CMS has shown some willingness to approve non-traditional programs that implement a work requirement for Medicaid benefits. Such action would kick out the low-income able bodied adults who benefit from Medicaid expansion and disqualify those same adults seeking coverage from Medicaid expansion.[https://www.theatlantic.com/politics/archive/2017/03/the-aca-isnt-out-of-the-woods-yet/520830/?utm_source=twb]
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Nine Republicans, both conservative and moderate, voted against the package.[https://www.nytimes.com/2017/07/25/us/politics/senate-health-care.html?hp&action=click&pgtype=Homepage&clickSource=story-heading&module=span-ab-top-region&region=top-news&WT.nav=top-news]
**Many adults who seek out Medicaid have a disability, a felony conviction or caregiver responsibilities. A work rquirement would make Medicare a weaker safety net.[https://www.theatlantic.com/politics/archive/2017/03/the-aca-isnt-out-of-the-woods-yet/520830/?utm_source=twb]
 
*Other potential waiver provisions could reduce Medicaid coverage and benefits including:
 
**requiring premiums and health-savings account contributions, moving more people to privately managed plans, and cutting benefits like the provision of medical transportation for enrollees.[https://www.theatlantic.com/politics/archive/2017/03/the-aca-isnt-out-of-the-woods-yet/520830/?utm_source=twb]
 
  
====Enacted Rule Changes====
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Next steps include 20 hours of debate on 2 out of 3 major Republican proposals:
 +
*'''Full repeal, with no replacement''' - '''Failed to pass with 43-57'''
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*'''Partial repeal''' - this version repeals the coverage provisions in the Affordable Care Act, including the individual mandate (requiring everyone sign up for insurance or receive a penalty), Medicaid expansion and premium subsidies, but it leaves in place insurance market reforms like ensuring a base level of coverage. - '''Still requires a vote'''
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*'''"Skinny" repeal''' - this version would repeal several parts of the ACA, but leave the Medicaid program. This would not lower premiums or eliminate ACA insurance regulations.[https://www.nytimes.com/interactive/2017/07/25/us/which-health-bill-will-the-senate-vote-on.html] - '''Still requires a vote'''
  
'''Market Stabilization Rule''' [https://www.axios.com/final-obamacare-rule-keeps-trump-administrations-market-changes-2359686105.html] [https://s3.amazonaws.com/public-inspection.federalregister.gov/2017-07712.pdf]
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Once debates are over at the end of July, the Senate will vote on dozens of amendments introduced by both Democrats and Republicans, leading up to a final bill.[https://www.nytimes.com/interactive/2017/07/25/us/which-health-bill-will-the-senate-vote-on.html]
*Gives insurers more flexibility in determining the "actuarial value" of their coverage.
 
*Open enrollment for next year has been shortened to six weeks, instead of three months as in previous years. (Nov. 1 to Dec. 15).
 
**People who try to sign up outside of the regular enrollment season will have to prove their eligibility.
 
**People who owe premiums from previous years will have to pay them before they can sign up for new coverage.
 
*States will be able to determine whether insurers have enough health care providers in their networks
 
  
'''Pulling Obamacare ads'''
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== [[File:notification.png | left | 50px | Impact of American Health Care Act (Part II) | link= ]] Impact of Health Care Bill Passed by the House==
*HHS and the Trump administration quickly pulled advertisements promoting Obamacare enrollment, ads that had been effective in previous years at getting young adults to sign up for coverage. [http://www.politico.com/magazine/story/2017/03/will-obamacare-really-explode-214949]
 
**It’s hard to say what effect that lower-than-expected enrollment will have on premiums directly, but the bigger problem could be the uncertainty it has created for insurers as they draft plans and premiums for next year.[http://www.politico.com/magazine/story/2017/03/will-obamacare-really-explode-214949]
 
**Any time there’s uncertainty, insurers will increase premiums more. [http://www.politico.com/magazine/story/2017/03/will-obamacare-really-explode-214949]
 
  
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The American Health Care Act (Part II) is a Republican replacement bill for the Affordable Care Act that was narrowly passed by the House of Representatives on May 4, 2017. There were two big changes made at the last minute: First, the GOP tacked on an extra $8 Billion for High Risk Pools, which knocks the savings down to $142.3 billion. Secondly, they added an option for individual states to opt out of the pre-existing condition protections, which would let carriers strip policies down to bare bones, charge those with such conditions more for coverage and so on. [http://acasignups.net/17/05/31/update-its-out-put-your-viking-helmet-its-cbo-scoring-day-part-one]
  
===Acts of Congress===
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===General Impacts===
*The United States Congress can and has create(d) legislation that will take small bites out of the ACA. The most notable was the delay of the Cadillac tax and reducing money allocated to the Prevention and Public Health Fund. [https://www.theatlantic.com/politics/archive/2017/03/the-aca-isnt-out-of-the-woods-yet/520830/?utm_source=twb]
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*Unusually, this version of the bill was passed before the nonpartisan Congressional Budget Office could make a report on how many people would be covered under the bill and how much it would cost. Now that it has been completed, the new CBO score for the new AHCA (Upton Amendment included) has projected a loss of coverage for 23 million people in a decade. [http://www.nbcnews.com/politics/politics-news/cbo-new-gop-health-care-law-would-leave-23-million-n764286] It also estimates that 1/6 of the population will see a destabilization in their insurance markets by 2020. [https://www.cbo.gov/system/files/115th-congress-2017-2018/costestimate/hr1628aspassed.pdf]
**Such smaller changes can produce drastic downstream effects.
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'''FIND UPDATED COVERAGE LOSSES BY CONGRESSIONAL DISTRICT'''[https://cdn.americanprogress.org/content/uploads/2017/05/25090745/CBOCoverageLossTableMay2017.xlsx]
  
==Impacts of the ACA==
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'''HEALTH COVERAGE LOSSES BY STATE (CBO SCORE UPDATE)'''
===Insurance Coverage by Congressional District===
 
  
 +
[[File:CBOscore by state.png]]
  
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'''Impacts of Essential Health Benefits waivers.'''
 +
*The bill allows states to waive (not require) rules requiring insurance companies to cover Essential Health Benefits, and rules that prevent insurance companies from charging some people more than others (known as community rating rules).[http://www.politico.com/f/?id=0000015b-8ab0-df96-a9db-dff115c30001]. This could leave sicker people, those with '''pre-existing conditions, '''with higher costs, pushing them into expensive high-risk pools (which are supposed to reduce costs for the healthier population, but cost the state and individuals a lot of money).
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*More than 130 million non-elderly Americans have preexisting conditions (chronic illnesses or past illnesses), and under the AHCA such people could end up spending thousands more on health insurance than they did under Obamacare. If a state files these waivers, it will be easier for insurers to discriminate against people who have a history of having more health problems.[https://www.americanprogress.org/issues/healthcare/news/2017/04/21/431019/premium-increases-pre-existing-conditions-latest-aca-repeal-plan-state/] *The average extra cost for certain health conditions can be seen [https://cdn.americanprogress.org/content/uploads/2017/04/21115927/Surcharges-for-pre-existing-conditions-by-state.xlsx here.]
  
*[http://kff.org/interactive/interactive-maps-estimates-of-enrollment-in-aca-marketplaces-and-medicaid-expansion/ Number of those '''gaining''' coverage through ACA exchanges and Medicaid expansion]
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'''Impacts on people with pre-existing conditions and community health ratings'''
*[https://fivethirtyeight.com/features/obamacare-has-increased-insurance-coverage-everywhere/ Number of those who still remain '''uninsured''']
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*The provision that allows young adults to stay under their parents' insurance until they turn 26 is still included in the new bill.[https://www.vox.com/policy-and-politics/2017/5/3/15531494/american-health-care-act-explained]
 +
*This table shows what premiums will be required of single people making 175 percent the federal poverty line. It shows that the AHCA raises premiums for older, poor Americans by as much as 850%
 +
[[File:AHCA1.jpeg]]
  
===Preexisting Conditions by Congressional District===
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===Healthcare from Employers===
*[https://cdn.americanprogress.org/content/uploads/2017/04/05080651/pre-existing-conditions-by-congressional-district.xlsx number of '''people with preexisting conditions''' ]
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* Under the AHCA, employers in states that use waivers can choose which regulations (10 Essential Health Benefits and requirements that would protect people with pre-existing conditions) they want to follow, to help lower the costs of their insurance plans. A company that operates in two states can drop protections allowed in one state, and use that same healthcare policy in another state that doesn't have a waiver. It's not clear whether employers would actually drop those protections. [http://www.businessinsider.com/gop-healthcare-bill-ahca-employer-insurance-2017-5]
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*Employers will not be required to offer insurance dating back to the beginning of 2016, and small businesses won't get tax credits to help offer insurance to their employees starting in 2020.[http://files.kff.org/attachment/Proposals-to-Replace-the-Affordable-Care-Act-Summary-of-the-American-Health-Care-Act]
  
===Benefits of the ACA===
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===Healthcare from Medicaid/Medicare===
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*One of the main ways Obamacare increased insurance coverage was by expanding the Medicaid program to cover millions more low-income Americans. Before Obamacare, Medicaid was restricted to specific groups of low-income Americans (including pregnant women, the blind and the [[Disability Rights|disabled]]). Obamacare opened up the program to anyone below 133% of the poverty line (about $15,000 for an individual) in the 31 states that opted to participate. Allowing more people to participate in Medicaid helped lower the rates for those who were uninsured. AHCA would end Medicaid expansion in 2020 and cut the program by $880 billion [https://www.vox.com/policy-and-politics/2017/5/3/15531494/american-health-care-act-explained]. Medicaid participation changes frequently because people's financial situation determines whether they are eligible. People who need to go back on Medicaid again, or for the first time, will not be able to do so after 2020.[https://www.vox.com/policy-and-politics/2017/5/3/15531494/american-health-care-act-explained]
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*The per-person limits on Medicaid spending will disproportionately harm the people who need health care the most, including people with [[Disability Rights|disabilities]] and the elderly.[https://www.vox.com/policy-and-politics/2017/5/3/15531494/american-health-care-act-explained]. The government would reimburse states using a "block grant," or one lump sum, instead of per-person payments. This would allow states to kick people off care, charge premiums, and cut benefits for children.[https://www.vox.com/policy-and-politics/2017/5/3/15531494/american-health-care-act-explained]
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*Phasing out the Medicaid expansion would disproportionately impact Americans with [[Disability Rights|disabilities]], '''10 million of whom are currently covered by Medicaid'''.[http://www.huffingtonpost.com/entry/disability-rights-donald-trump_us_582487fae4b0e80b02cefa2f] The new proposal could also shift money away from [[Educational Justice|schools]], which receive Medicaid reimbursements for speech and occupation therapy, wheelchairs, and specialized playground equipment.[https://www.disabilityscoop.com/2017/05/04/house-health-alarming-advocates/23666/]
  
*About 20 million people gained insurance.[http://blogs.wsj.com/briefly/2017/01/03/5-things-things-to-know-about-the-affordable-care-act/]
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===Private Healthcare===
**largely the result of expanding Medicaid, the federal insurance program for people with low incomes. there’s short term threats to Medicaid if it is left as is.[https://fivethirtyeight.com/features/the-future-of-obamacare-is-in-trumps-hands/?ex_cid=538fb]
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*The Congressional Budget Office has not yet estimated how the cost of privately purchased health care would change.
*The uninsured population of the US went from 16% in 2010 to 9% in 2015.[http://www.economist.com/news/united-states/21706527-obamacares-future-not-yet-secure-encumbered-exchange][http://www.npr.org/2017/03/27/521441490/fact-check-trump-says-obamacare-is-exploding-its-not]
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*The White House and House GOP members agreed to an amendment, the Upton Amendment, that adds $8 billion over 5 years to help sicker people pay for health insurance. But this amount of money is probably only enough to cover 76,000 of the 130 million people living with a pre-existing condition. Such people are put in so-called high-risk pools, with very high insurance premiums.[https://www.americanprogress.org/issues/healthcare/news/2017/05/03/431827/upton-amendment-aca-repeal-bill-will-almost-no-effect/][http://www.politico.com/story/2017/05/02/health-care-republicans-obamacare-237910] The Center for American Progress estimates that the Upton Amendment will have "almost no effect".[https://www.americanprogress.org/issues/healthcare/news/2017/05/03/431827/upton-amendment-aca-repeal-bill-will-almost-no-effect/]
*15.7 million people gained access to Medicaid.[https://web.archive.org/web/20170131014400/https://www.hhs.gov/healthcare/facts-and-features/fact-sheets/new-report-details-impact-affordable-care-act.html]
 
  
===Criticisms of the ACA===
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===Tax Cuts for the Wealthy===
*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.[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3767707/]
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*Obamacare included tax increases that hit wealthy Americans hardest in order to pay for its coverage expansion. The AHCA would get rid of those taxes increases, leading to tax cuts of $883 billion. Most of these would benefit the wealthy, according to the Congressional Budget Office. Obamacare was one of the biggest redistributions of wealth from the rich to the poor; the AHCA would reverse that.[https://www.vox.com/policy-and-politics/2017/5/3/15531494/american-health-care-act-explained]
*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.[https://www.medicaid.gov/affordable-care-act] There is still a significant coverage gap for people who can't receive Medicaid (see above) or exchange subsidies.
+
*The bill discontinues two taxes that helped to pay for Obamacare—a Medicare payroll tax and a [[Benefits / Tax Cuts|3.8% tax on investment income]] for people who earn over $200,000 (or couples who earn over $250,000).[https://mobile.nytimes.com/2017/05/04/upshot/who-wins-and-who-loses-in-the-latest-gop-health-care-bill.html]  
*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.[http://www.npr.org/2017/03/27/521441490/fact-check-trump-says-obamacare-is-exploding-its-not][http://www.npr.org/sections/health-shots/2015/09/22/442546652/rising-health-deductibles-take-bigger-bite-out-of-family-budgets]
+
*The bill lets people save more of their money in tax-free health savings accounts (about twice as much as what was allowed with ACA).[http://files.kff.org/attachment/Proposals-to-Replace-the-Affordable-Care-Act-Summary-of-the-American-Health-Care-Act]. This allows wealthier people to get tax breaks through a pre-tax account, grow their funds tax-free, and use this money for healthcare expenses tax-free.
*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.[http://www.economist.com/news/united-states/21706527-obamacares-future-not-yet-secure-encumbered-exchange] 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.[http://www.economist.com/news/united-states/21706527-obamacares-future-not-yet-secure-encumbered-exchange][http://blogs.wsj.com/briefly/2017/01/03/5-things-things-to-know-about-the-affordable-care-act/] Premiums have definitely increased, but not for most people purchasing through the exchanges, since subsidies have also increased.[http://www.politifact.com/truth-o-meter/statements/2017/mar/23/barack-obama/obama-no-premium-hike-vast-majority-covered-govern/]
 
*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.[http://www.economist.com/news/united-states/21706527-obamacares-future-not-yet-secure-encumbered-exchange][http://www.wsj.com/articles/health-insurers-pullback-threatens-to-create-monopolies-1472408338]
 
**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.[https://fivethirtyeight.com/features/the-future-of-obamacare-is-in-trumps-hands/?ex_cid=538fb]
 
  
*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.[http://www.npr.org/2017/03/27/521441490/fact-check-trump-says-obamacare-is-exploding-its-not]
+
==Vulnerabilities==
*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.[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3767707/]
+
====A Small Majority====
 +
In the Senate, there is a small Republican majority, of only 52 Republicans to 48 Democrats. This means that Republicans can only afford to lose three supporting votes.[http://www.nbcnews.com/politics/first-read/gop-faces-three-challenges-health-care-heads-senate-n755346]
  
==Affordable Care Act==
+
Senate Majority Leader Mitch McConnell can try to pass the bill through "budget reconciliation," which is a simple majority vote, rather than the typical 2/3 majority required to pass legislation to overcome a filibuster. Budget reconciliation cannot be filibustered.[https://www.washingtonpost.com/powerpost/if-house-passes-gop-health-care-bill-a-steeper-climb-awaits-in-the-senate/2017/05/04/26a901da-30bd-11e7-8674-437ddb6e813e_story.html?utm_term=.d8e96d0e4c34]
The Patient Protection and Affordable Care Act[https://web.archive.org/web/20170118123143/https://www.hhs.gov/healthcare/about-the-law/read-the-law/index.html], 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.[http://blogs.wsj.com/briefly/2017/01/03/5-things-things-to-know-about-the-affordable-care-act/][https://www.thebalance.com/obamacare-explained-3306058][https://web.archive.org/web/20170118175059/https://www.healthcare.gov/quick-guide/one-page-guide-to-the-marketplace/]
 
  
===People Receiving Healthcare from Employers===
+
====Budget Reconciliation/The Byrd Rule====
 +
One of the process’s most important provisions is that reconciliation bills must be about budgets only, not changing laws. That's why the measure to repeal ACA's individual mandate penalties seems allowable. [http://www.dailykos.com/story/2017/3/21/1645811/-Budget-Reconciliation-Coverage-Mandates-and-the-AHCA] The Byrd rule in the Senate requires that all provisions in a bill that goes through the reconciliation process have to deal with the federal budget. That means various parts of the AHCA, like gutting Obamacare regulations on insurers and allowing states to waive essential health benefits and protections for people with pre-existing conditions, could fail to qualify in the Senate. [http://www.businessinsider.com/ahca-trumpcare-obamacare-repeal-senate-vote-obamacare-repeal-2017-5]
  
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.[https://web.archive.org/web/20170126102039/https://www.hhs.gov/healthcare/about-the-law/pre-existing-conditions/index.html] 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.[https://web.archive.org/web/20170126061044/https://www.hhs.gov/healthcare/about-the-law/benefit-limits/index.html] 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.[http://www.economist.com/news/united-states/21706527-obamacares-future-not-yet-secure-encumbered-exchange]
+
====Midterm Elections in 2018====
 +
Because the bill has passed the House, most resistance efforts will now focus on the Senate. Republicans who support the bill and are up for re-election in 2018 are most likely to respond to pressure to oppose passing the bill. These upcoming elections are especially important considering that just 31 percent of Americans are either "favorable" or "somewhat favorable" towards the ACHA. [https://thinkprogress.org/trumpcare-poll-unpopular-ccbd6462d418] 9 Senate Republicans are up for re-election in 2018, and most of them come from consistently red states. The exceptions to this are Jeff Flake and Dean Heller.[http://www.washingtonexaminer.com/with-eyes-on-midterms-flake-and-heller-feel-the-pressure-from-both-sides/article/2613886] If you live in one of these states, call '''tel:202-224-3121''' and ask for these senators' offices:
  
===People Receiving Healthcare from Medicaid/Medicare===
+
*Jeff Flake, [[Arizona]]
 +
*Roger Wicker, [[Mississippi]]
 +
*Deb Fischer, [[Nebraska]]
 +
*Dean Heller, [[Nevada]]
 +
*Bob Corker, [[Tennessee]]
 +
*Ted Cruz, [[Texas]]
 +
*Orrin Hatch, [[Utah]]
 +
*John Barrasso, [[Wyoming]]
  
The law increased Medicaid eligibility to those who earn 138% of the federal poverty limit.[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3767707/] 15.7 million people gained Medicaid under the ACA.[https://web.archive.org/web/20170131014400/https://www.hhs.gov/healthcare/facts-and-features/fact-sheets/new-report-details-impact-affordable-care-act.html] 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."[http://kff.org/uninsured/issue-brief/the-coverage-gap-uninsured-poor-adults-in-states-that-do-not-expand-medicaid/]
+
'''What to Say When You Call:''' "The AHCA will cause severe negative impacts on low-income people and only benefits the wealthy. I am calling to urge the senator to vote against the healthcare bill that was passed without an assessment from the Congressional Budget Office."
  
===People Purchasing Healthcare Privately===
+
====Time====
 +
The Senate cannot take up the vote until the Congressional Budget Office finishes its analysis of its costs, which is expected to take one to two weeks.[http://www.nbcchicago.com/news/politics/Health-Care-Bill-Likely-to-Spend-More-Time-in-Senate-421414773.html]
  
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.[https://web.archive.org/web/20170118175059/https://www.healthcare.gov/quick-guide/one-page-guide-to-the-marketplace/] Subsidies are available to people earning less than 400% of the [https://www.healthcare.gov/glossary/federal-poverty-level-FPL/ federal poverty level], lowering the amount they have to pay.[http://www.economist.com/news/united-states/21706527-obamacares-future-not-yet-secure-encumbered-exchange]
+
On Thursday, May 4, Senator John Corbyn (R-[[Texas]]) said, "We're not under any deadline, so we're going to take our time." Senator James Lankford (R-[[Oklahoma]]) also said the version of the bill that the House approved is "definitely still not the final product."[http://www.nbcchicago.com/news/politics/Health-Care-Bill-Likely-to-Spend-More-Time-in-Senate-421414773.html]
  
==CHIP==
+
====All Votes====
'''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.[https://www.medicaid.gov/chip/chip-program-information.html]
+
See the complete list of how each representative voted [https://www.nytimes.com/interactive/2017/05/04/us/politics/house-vote-republican-health-care-bill.html/here].
 
 
For more information about eligibility and applying for CHIP, please [https://www.benefits.gov/benefits/benefit-details/607 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 [http://www.nbcnews.com/health/health-news/trump-proposes-slashing-medical-research-year-too-n739761]:
 
**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
 
===Rural Communities===
 
*The Trump Administration has altered the timetable for some visa applications through the use of the travel ban. As it is being challenged in court the decision will likely to delay the arrival of new foreign doctors.[https://www.nytimes.com/2017/03/18/us/doctor-shortage-visa-policy.html?smid=tw-share&_r=3]
 
** The U.S. Citizenship and Immigration Services has temporarily suspended “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. [https://www.nytimes.com/2017/03/18/us/doctor-shortage-visa-policy.html?smid=tw-share&_r=3]
 
**This has and will 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. [https://www.nytimes.com/2017/03/18/us/doctor-shortage-visa-policy.html?smid=tw-share&_r=3]
 

Latest revision as of 14:15, 26 July 2017

This is a collaborative knowledge base; feel free to propose edits/additions that you believe are important for others to know. Contributions will be reviewed and approved based on quality and accuracy.

How You Can Resist
How You Can Resist
[edit]

Updates
Recent Updates
[edit]

  • 7/25/17 The Senate voted to open debates on a bill to repeal major parts of the Affordable Care Act (ACA). However hours later, the Republican Senate failed to receive the 60 votes needed to pass their most detailed plan to replace the ACA. The Senate is now moving ahead with debate, amendments (changes) and a final vote in the coming days on legislation. If passed, the bill would have big effect on the American health care system which accounts for almost one-sixth of the United States’ economy.[1]
  • 7/16/17 The Congressional Budget Office postponed release of an analysis on the latest GOP healthcare bill. They did not give an explanation or an estimate when the analysis was expected. [2]
  • 7/16/17 The Senate vote on the healthcare bill was delayed due to the absence of Senator John McCain, who is recovering from surgery. The vote is predicted to be close.[3]
  • 7/14/17 Two GOP senators have indicated that they oppose the healthcare bill, and 11 others have expressed concerns with some form of the bill. The bill will not pass if there are 3 Republican votes against it.[4]
  • 6/29/2017 A new CBO score analysis says that the Republican plan to change how Medicaid payments are calculated has a deeper impact thn previously thought. The new analysis says that the government would spend 35 percent less on Medicaid than under the current law, compared with a 26 percent decrease in the first decade. [5]
  • 6/28/2017 Senate Majority Leader McConnell has announced that the vote on the Better Care Reconcilliation Act will be delayed until after the July 4th recess due to growing opposition among Senate Republicans. [6]
  • 6/22/2017 Senate Republicans have released a "discussion draft" of their bill to repeal and replace Obamacare. A vote is planned for before the July 4th recess. [7] [8]
  • 6/18/2017 Senate Democrats are considering shutting down the Senate in an attempt to force GOP to show their healthcare repeal bill. This bill is being negotiated in secret among some Republicans. To do this, they may:
    • hold the Senate floor for a long period;
    • refuse to hold committee meetings; or
    • refuse to allow routine business in the Senate.[9]
  • 6/10/2017 The Trump Administration is showing signs of delaying the payments of Obamacare cost-sharing subsidies. These funds are critical to keep insurance companies on Obamacare exchanges. The White House has also signaled that Congress may need to appropriate funds in the event they decide not to fund it. Meanwhile Obamacare deserts are continuing to spread. [10]
  • 6/06/2017 Budget reconciliation, also called simply “reconciliation,” lets the Senate majority pass legislation with 50 votes, instead of the usual 60. [11] The health care bill passed by the House complies with the Senate’s reconciliation process, which means it will only take 50 votes to pass the Senate version. [12]
  • 6/05/2017 Senate Majority Leader Mitch McConnell hopes to send a private draft bill of the the Senate's AHCA to the Congressional Budget Office this week. [13]
  • 6/05/2017 The Senate hopes to bring an Obamacare repeal bill to a vote. Many Republicans are pessimistic about getting to the 50 vote threshold, because a consensus has been hard to come to. Prominent Republican Senator Cornyn says that the Senate bill mirror about 80% of the AHCA. [14] [15]

What We Know About the Latest Proposed Senate Healthcare Bill
What We Know About the Senate Healthcare Bill
[edit]

Senate Republicans plan to draft variations of a bill behind closed doors and releasing the draft right before it comes up for a vote, planned for the end of July. The Senate has also proposed an option to repeal with no replacement. On July 25th, only two Republicans, Susan Collins of Maine and Lisa Murkowski of Alaska, voted against the motion to debate, though at least several other Republicans had been expected to potentially vote against as well. No Democrats voted in favor to debate a Republican replacement bill.[16]

The June 25th vote was on a detailed update (amendment) meant to please conservatives and moderates in the Republican caucus. One proposal, offered by Senator Ted Cruz, Republican of Texas, would have allowed insurers to sell stripped-down "skinny" health plans, without maternity care or other benefits required by the Affordable Care Act, if they also sold plans that included such benefits. The amendment also included money to help pay out-of-pocket medical costs for low-income people, including those who buy private insurance after losing Medicaid coverage as a result of the Senate bill. This proposal was written by Senator Rob Portman, Republican of Ohio, and other senators from states that have expanded Medicaid under the Affordable Care Act.[17] ] Nine Republicans, both conservative and moderate, voted against the package.[18]

Next steps include 20 hours of debate on 2 out of 3 major Republican proposals:

  • Full repeal, with no replacement - Failed to pass with 43-57
  • Partial repeal - this version repeals the coverage provisions in the Affordable Care Act, including the individual mandate (requiring everyone sign up for insurance or receive a penalty), Medicaid expansion and premium subsidies, but it leaves in place insurance market reforms like ensuring a base level of coverage. - Still requires a vote
  • "Skinny" repeal - this version would repeal several parts of the ACA, but leave the Medicaid program. This would not lower premiums or eliminate ACA insurance regulations.[19] - Still requires a vote

Once debates are over at the end of July, the Senate will vote on dozens of amendments introduced by both Democrats and Republicans, leading up to a final bill.[20]

Impact of American Health Care Act (Part II)
Impact of Health Care Bill Passed by the House
[edit]

The American Health Care Act (Part II) is a Republican replacement bill for the Affordable Care Act that was narrowly passed by the House of Representatives on May 4, 2017. There were two big changes made at the last minute: First, the GOP tacked on an extra $8 Billion for High Risk Pools, which knocks the savings down to $142.3 billion. Secondly, they added an option for individual states to opt out of the pre-existing condition protections, which would let carriers strip policies down to bare bones, charge those with such conditions more for coverage and so on. [21]

General Impacts[edit]

  • Unusually, this version of the bill was passed before the nonpartisan Congressional Budget Office could make a report on how many people would be covered under the bill and how much it would cost. Now that it has been completed, the new CBO score for the new AHCA (Upton Amendment included) has projected a loss of coverage for 23 million people in a decade. [22] It also estimates that 1/6 of the population will see a destabilization in their insurance markets by 2020. [23]

FIND UPDATED COVERAGE LOSSES BY CONGRESSIONAL DISTRICT[24]

HEALTH COVERAGE LOSSES BY STATE (CBO SCORE UPDATE)

CBOscore by state.png

Impacts of Essential Health Benefits waivers.

  • The bill allows states to waive (not require) rules requiring insurance companies to cover Essential Health Benefits, and rules that prevent insurance companies from charging some people more than others (known as community rating rules).[25]. This could leave sicker people, those with pre-existing conditions, with higher costs, pushing them into expensive high-risk pools (which are supposed to reduce costs for the healthier population, but cost the state and individuals a lot of money).
  • More than 130 million non-elderly Americans have preexisting conditions (chronic illnesses or past illnesses), and under the AHCA such people could end up spending thousands more on health insurance than they did under Obamacare. If a state files these waivers, it will be easier for insurers to discriminate against people who have a history of having more health problems.[26] *The average extra cost for certain health conditions can be seen here.

Impacts on people with pre-existing conditions and community health ratings

  • The provision that allows young adults to stay under their parents' insurance until they turn 26 is still included in the new bill.[27]
  • This table shows what premiums will be required of single people making 175 percent the federal poverty line. It shows that the AHCA raises premiums for older, poor Americans by as much as 850%

AHCA1.jpeg

Healthcare from Employers[edit]

  • Under the AHCA, employers in states that use waivers can choose which regulations (10 Essential Health Benefits and requirements that would protect people with pre-existing conditions) they want to follow, to help lower the costs of their insurance plans. A company that operates in two states can drop protections allowed in one state, and use that same healthcare policy in another state that doesn't have a waiver. It's not clear whether employers would actually drop those protections. [28]
  • Employers will not be required to offer insurance dating back to the beginning of 2016, and small businesses won't get tax credits to help offer insurance to their employees starting in 2020.[29]

Healthcare from Medicaid/Medicare[edit]

  • One of the main ways Obamacare increased insurance coverage was by expanding the Medicaid program to cover millions more low-income Americans. Before Obamacare, Medicaid was restricted to specific groups of low-income Americans (including pregnant women, the blind and the disabled). Obamacare opened up the program to anyone below 133% of the poverty line (about $15,000 for an individual) in the 31 states that opted to participate. Allowing more people to participate in Medicaid helped lower the rates for those who were uninsured. AHCA would end Medicaid expansion in 2020 and cut the program by $880 billion [30]. Medicaid participation changes frequently because people's financial situation determines whether they are eligible. People who need to go back on Medicaid again, or for the first time, will not be able to do so after 2020.[31]
  • The per-person limits on Medicaid spending will disproportionately harm the people who need health care the most, including people with disabilities and the elderly.[32]. The government would reimburse states using a "block grant," or one lump sum, instead of per-person payments. This would allow states to kick people off care, charge premiums, and cut benefits for children.[33]
  • Phasing out the Medicaid expansion would disproportionately impact Americans with disabilities, 10 million of whom are currently covered by Medicaid.[34] The new proposal could also shift money away from schools, which receive Medicaid reimbursements for speech and occupation therapy, wheelchairs, and specialized playground equipment.[35]

Private Healthcare[edit]

  • The Congressional Budget Office has not yet estimated how the cost of privately purchased health care would change.
  • The White House and House GOP members agreed to an amendment, the Upton Amendment, that adds $8 billion over 5 years to help sicker people pay for health insurance. But this amount of money is probably only enough to cover 76,000 of the 130 million people living with a pre-existing condition. Such people are put in so-called high-risk pools, with very high insurance premiums.[36][37] The Center for American Progress estimates that the Upton Amendment will have "almost no effect".[38]

Tax Cuts for the Wealthy[edit]

  • Obamacare included tax increases that hit wealthy Americans hardest in order to pay for its coverage expansion. The AHCA would get rid of those taxes increases, leading to tax cuts of $883 billion. Most of these would benefit the wealthy, according to the Congressional Budget Office. Obamacare was one of the biggest redistributions of wealth from the rich to the poor; the AHCA would reverse that.[39]
  • The bill discontinues two taxes that helped to pay for Obamacare—a Medicare payroll tax and a 3.8% tax on investment income for people who earn over $200,000 (or couples who earn over $250,000).[40]
  • The bill lets people save more of their money in tax-free health savings accounts (about twice as much as what was allowed with ACA).[41]. This allows wealthier people to get tax breaks through a pre-tax account, grow their funds tax-free, and use this money for healthcare expenses tax-free.

Vulnerabilities[edit]

A Small Majority[edit]

In the Senate, there is a small Republican majority, of only 52 Republicans to 48 Democrats. This means that Republicans can only afford to lose three supporting votes.[42]

Senate Majority Leader Mitch McConnell can try to pass the bill through "budget reconciliation," which is a simple majority vote, rather than the typical 2/3 majority required to pass legislation to overcome a filibuster. Budget reconciliation cannot be filibustered.[43]

Budget Reconciliation/The Byrd Rule[edit]

One of the process’s most important provisions is that reconciliation bills must be about budgets only, not changing laws. That's why the measure to repeal ACA's individual mandate penalties seems allowable. [44] The Byrd rule in the Senate requires that all provisions in a bill that goes through the reconciliation process have to deal with the federal budget. That means various parts of the AHCA, like gutting Obamacare regulations on insurers and allowing states to waive essential health benefits and protections for people with pre-existing conditions, could fail to qualify in the Senate. [45]

Midterm Elections in 2018[edit]

Because the bill has passed the House, most resistance efforts will now focus on the Senate. Republicans who support the bill and are up for re-election in 2018 are most likely to respond to pressure to oppose passing the bill. These upcoming elections are especially important considering that just 31 percent of Americans are either "favorable" or "somewhat favorable" towards the ACHA. [46] 9 Senate Republicans are up for re-election in 2018, and most of them come from consistently red states. The exceptions to this are Jeff Flake and Dean Heller.[47] If you live in one of these states, call tel:202-224-3121 and ask for these senators' offices:

What to Say When You Call: "The AHCA will cause severe negative impacts on low-income people and only benefits the wealthy. I am calling to urge the senator to vote against the healthcare bill that was passed without an assessment from the Congressional Budget Office."

Time[edit]

The Senate cannot take up the vote until the Congressional Budget Office finishes its analysis of its costs, which is expected to take one to two weeks.[48]

On Thursday, May 4, Senator John Corbyn (R-Texas) said, "We're not under any deadline, so we're going to take our time." Senator James Lankford (R-Oklahoma) also said the version of the bill that the House approved is "definitely still not the final product."[49]

All Votes[edit]

See the complete list of how each representative voted [50].