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- 1 How You Can Resist
- 2 Recent Updates
- 3 Impact of Health Care Bill Passed by the House
- 4 Vulnerabilities
How You Can Resist
- Call your Senator by dialing tel:844-6-RESIST and tell them to oppose repealing the Affordable Care Act.
- Find out when your Senators are holding town halls and other Upcoming Events/Opportunities. Show up and tell them not to repeal the Affordable Care Act.
- 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 here.
- Find health-care organizations with volunteer opportunities, with nationwide networks of groups, and with information and opportunities for online activism.
- 5/17/2017 Today the House holds a hearing on funding for the National Institutes of Health. The Trump Administration had proposed a $6 billion cut to the NIH. dozens of medical and research advocacy organizations have asked Secretay Price to preserve funding for the NIH. 
- 5/17/2017 The HHS Department is now allowing states to obtain innovation waivers, that help set up risk pools and reinsurance programs. The Obama administration met these waivers with scrutiny because they could undercut the ACA's (often expensive) protections. A checklist offered by the Department will help speed up state request for these waivers. 
- 5/17/2017 An analysis by the Kaiser Foundation found that 6.3 million people will be under risk if the House AHCA bill becomes law. 27 million Americans experienced a multi-month coverage gap in 2015, 23 percent of that population had pre-existing conditions. Under the AHCA, these individuals could face significant premium hikes if their state obtains a waiver that allows insurers to vary premiums by health status. *These numbers are dependent on which states use a waiver and how they implement them. 
- 5/15/2017 Bipartisan talks were held in the Senate late Monday evening to discuss the future of Obamacare. Majority Leader McConnell had formed an all-Republican negotiating team that will help their party gain the 50 votes needed for a repeal. Both parties could lose political capital in these talks, but some moderate Democrats seem to want to find common ground. 
- 5/11/2017 The AHCA includes a measure that makes it easier for states to overturn Title X protections. Title X requires comprehensive family planning services. According to the Center of American Progress, community health centers will have a harder time serving the client base of Planned Parenthood (low-income women) due to this drop in protections. This could lead to an increase in STIs (sexually-transmitted infections) and pregnancy rates (which are currently at a 30-year low). 
- 5/4/2017: The House narrowly passed the American Health Care Act, known as the "Obamacare Repeal" bill. It may be harder for the bill to pass in the Senate, where members of both parties have concerns about the bill's effect on Americans' healthcare and the economy.
*5/1/2017: The budget passed by the House and Senate agrees to continue to pay Obamacare subsidies and generously funds Obama's cancer "moonshot".
Impact of Health Care Bill Passed by the House
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.
- 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. The CBO had estimated that under the previous version of the bill, 14 million people would become uninsured by 2018, mostly as a result of repealing the individual mandate (the requirement to purchase insurance or pay a penalty). They also estimated that 21 million more people would be uninsured in 2020 and 24 million more people uninsured in 2026 than if the Affordable Care Act stayed in place, largely because of the changes in Medicaid the bill proposed.
- 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).. 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. The average extra cost for certain health conditions can be seen here.
- The provision that allows young adults to stay under their parents' insurance until they turn 26 is still included in the new bill.
Healthcare from Employers
- The Upton Amendment proposed in the AHCA allows states to waive requirements that would protect people with pre-existing conditions, and the AHCA does not require protecting the 10 Essential Health Benefits covered under Obamacare. Under the AHCA, employers in states that use waivers can choose which regulations 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. 
- 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.
Healthcare from Medicaid/Medicare
- 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 . 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.
- 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.. 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.
- Medicare's trust fund will run out in 2025 instead of 2029, which will make it impossible to provide seniors with health insurance.
- Phasing out the Medicaid expansion would disproportionately impact Americans with disabilities, 10 million of whom are currently covered by Medicaid. The new proposal could also shift money away from schools, which receive Medicaid reimbursements for speech and occupation therapy, wheelchairs, and specialized playground equipment.
- 1.3 million people who currently receive treatment for mental health and addiction services through the Medicaid expansion would lose their coverage.
- For the first time, states would be able to add a work requirement to be eligible for Medicaid for nondisabled, nonpregnant and nonelderly people.. Research has found that work requirements for welfare aren't effective in getting more people to work in the long term.
- 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. The Center for American Progress estimates that the Upton Amendment will have "almost no effect".
- One estimate from the first version of the bill found that it would increase costs for the average enrollee by $1,542 if the bill were in effect today. In 2020, the bill would increase costs for the average enrollee by $2,409.
- The impact of the bill would be particularly severe for middle-aged and older people, ages 55 to 64. Their costs would increase by $5,269 if the bill went into effect today and by $6,971 in 2020.
- Individuals with income below 250% of the federal poverty line (approximately $60,000 for a family of four) would see their costs increase by $2,945 today and by $4,061 in 2020.
- Defunding Planned Parenthood would limit options for low-income women on Medicaid to receive health care, and would cut off affordable abortion options for many women. The Congressional Budget Office estimated that in the first version of the bill, about 15% of the people who currently use Planned Parenthood would lose access to health care. This is probably the same in the current version of the bill.
- The bill encourages insurers not to offer plans that cover abortion services, since these plans can't be purchased with tax credits.
- Married people are only eligible for [[Benefits / Tax Cuts|tax credits] to help pay for health insurance coverage if they file a joint tax return. This will harm married people in unsafe or difficult marital situations (disproportionately affecting women). By requiring married couples to file joint returns, the bill ignores situations where filing jointly may not be possible or safe, including physical or mental spousal abuse, pending divorce, or when one spouse is incarcerated.
- The "Joint Filing Requirement" would, for example, require an abuse survivor to share information with their abusive spouse. This might include sensitive information like a new physical address, phone number, employer or bank account. In the case of an abandoned spouse, there is no spouse for the purposes of joint tax filing. With this repeal bill, people (usually women) in these two scenarios would not be eligible for tax credits to purchase health insurance.
Tax Cuts for the Wealthy
- 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.
- 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).
- 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).. 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.
- The bill ends contribution limits to Flexible Spending Accounts, an employee's tax-free savings account for medical expenses.
- The bill ends the limit on deductions for people employed by publicly held corporations and who earn more than $1 million.
- The plan offers tax breaks to insurance companies that pay their CEOs more than $500,000 per year, which makes it profitable for companies to overpay their top executives.
- The plan eliminates a 10% tax on indoor tanning salons, a 2.3% tax on medical devices, and a 0.9% additional Medicare tax on the wages of upper-income taxpayers.
- The plan will also eliminate a 3.8% tax on almost all earnings from investments. 90% of the money collected from this tax comes from the top 1% of Americans. Eliminating this tax increases the incomes of the 0.1% by on an average of $165,000 a year.
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.
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.
Budget Reconciliation/The Byrd Rule
One of the process’ most important provisions is that reconciliation bills must be solely budgetary and cannot contain any provisions that enact, repeal, or amend regulatory law. That's why the measure to repeal ACA's individual mandate penalties seems allowable.  The Byrd rule in the Senate, requires that all provisions in a bill that goes through the reconciliation process has to deal with the federal budget. That means various parts of the AHCA, like gutting Obamacare regulations on insurers and allow states to waive Essential Health Benefits and protections for people with pre-existing conditions, could fail to qualify in the Senate. 
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. 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.. If you live in one of these states, call tel:202-224-3121 and ask for these senators' offices:
- Jeff Flake, Arizona
- Roger Wicker, Mississippi
- Deb Fischer, Nebraska
- Dean Heller, Nevada
- Bob Corker, Tennessee
- Ted Cruz, Texas
- Orrin Hatch, Utah
- John Barrasso, Wyoming
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."
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.
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."
See the complete list of how each representative voted .