Yesterday, Members of the House of Representatives introduced Affordable Care Act (ACA) repeal and replacement legislation in the Ways and Means and Energy and Commerce Committees. According to a blog post from Health Affairs, the committees will begin markup of the bills tomorrow, March 8, and the House is hoping to pass a repeal and replacement bill in the next three weeks.
The two bills would not repeal the ACA entirely. They would leave in place many of the ACA’s insurance reforms including: coverage for people with pre-existing conditions; guaranteed availability of coverage; coverage of young adult children under their parents’ health plans until age 26; and annual out-of-pocket maximums. The bills would also leave in place certain consumer protections including the ban on discrimination on the basis of race, nationality, disability, age, or sex.
However, there are a number of provisions in the two bills that would harm consumers. These include:
- Medicaid would be transitioned to a per capita cap program by 2020. This means that the federal government would provide a fixed amount of money to each state per enrollee, rather than a percentage of the total costs per enrollee.
- Federal funding for Medicaid expansion would be eliminated.
- States would be provided incentives to re-determine Medicaid eligibility more frequently. In New York, many Medicaid enrollees have 12-month continuous Medicaid coverage.
Undermining Coverage Gains
- Individuals would no longer face a tax penalty for not having coverage. Instead, premiums would go up by 30 percent as a penalty for consumers who do not maintain continuous coverage during the 12 months preceding enrollment in a new plan.
- Employers would no longer be penalized for not offering coverage to their employees and dependents.
Eroding Marketplace Affordability
- States would be allowed to charge older consumers premiums 5 times greater than those of younger consumers. Currently, insurers are only allowed to charge only consumers 3 times as much as younger consumers.
- The current income-based advanced premium tax credits would be replaced with tax credits based on age. This means that a low-income consumer would receive the same tax credit as a wealthy consumer in the same age bracket.
- Cost-sharing reductions for eligible consumers with incomes under 250 percent of the Federal Poverty Level would be eliminated after 2019.
- Plans sold through the Marketplace would provide less coverage for health services, and consumers would be responsible for more out-of-pocket costs.
Reducing Access to Family Planning Services
- Planned Parenthood would lose federal funding for one year if the bills become law.
New York Representatives Chris Collins and Paul Tonko serve on the Energy and Commerce Committee, and Representatives Tom Reed and Joe Crowley serve on the Ways and Means Committee. If you or someone you know would be affected by the changes proposed in these two bills, please call your elected Representatives today at 1-866-426-2631.
A few weeks ago, HCFANY members served on the “Challenges and Opportunities of the Trump Era: Healthcare for Special Populations” panel at the New York State Association of Black and Puerto Rican Legislators’ 46th Annual Legislative Caucus Weekend. Senator Gustavo Rivera facilitated the panel, which included a distinguished selection of labor, health care providers, advocates, and social service providers including: District Council 37’s Henry Garrido, Therese Rodriquez of Apicha Community Health Center, and Wendy Stark of Callen-Lorde Community Health Center.
Claudia Calhoon from the New York Immigration Coalition and Amanda Lugg of African Services Committee represented HCFANY’s Coverage 4 All Campaign. Arline Cruz from Make the Road New York and Juan Pinzon from the Community Service Society spoke on behalf of funding for the Community Health Advocates, New York State’s Health Consumer Assistance Program.
The conversation focused on the ways that drastic federal changes in health and immigration policy will affect health access and coverage for low-income, LGBTQ, and immigrant populations. New York State residents from these groups will be profoundly affected by proposed reductions in federal financing for health care promised by ACA repeal and proposed Medicaid cuts. Increased immigration enforcement activities have recently created paralyzing fear among immigrant communities and have discouraged people from visiting hospitals or sending their children to school.
In particular, the panel focused on the importance of three critical initiatives:
- Enhanced Safety Net Hospital legislation (A9476/S6948A), passed unanimously by both houses in 2016, that would create a new category of safety net hospital that reflects the actual quantity of indigent and low-income care provided and sustains those institutions;
- Expanding coverage to young adults regardless of immigration status by raising the eligibility of the Child Health Plus program to age 29;
- Fully funding the New York State’s Community Health Advocates consumer assistance program so that their sites may continue to distribute information in the face of potential change to healthcare.
In the face of these major changes, New York State has the opportunity to lead the nation by ensuring that its most vulnerable populations can access the full range of health care services from preventive to specialty care when they need them, as well as ensuring that they have the information they need to navigate and use their health coverage. It is also critical to strengthen the financial well-being of public hospitals and federally-qualified health centers across New York State that care for many immigrant and LGBTQ populations.
HCFANY looks forward to working with all its partners to protect health care access and coverage in the face of uncertainty and change on these and other priorities. Organizations interested in signing on to the Coverage 4 All campaign can do so here.
Last week, the Centers for Medicare and Medicaid Services (CMS) issued a proposed rule for 2018. According to the press release, the proposed rule includes “reforms that are critical to stabilizing the individual and small group health insurance markets to help protect patients.”
However, many of the policy changes in the proposed rule would harm consumers. For example, a recent analysis from the non-partisan Center on Budget and Policy Priorities explains that the proposed rule would reduce the advanced premium tax credits that help make plans purchased through the Marketplace more affordable for moderate-income individuals in families.
According to the analysis, the proposed rule would result in lower tax credits because it lowers the actuarial value standards for “silver” level plans. This means that premiums and the percentage of costs covered by the insurer would decrease, but deductibles and copayments for consumers would increase. Under the Affordable Care Act, tax credits for consumers purchasing coverage through the Marketplace are calculated based on the second lowest cost silver plan. By allowing for lower value silver plans, the new rule would force consumers to pay more out of pocket to maintain their current level of coverage.
Furthermore, the CMS proposed rule also includes provisions to require consumers to provide supporting documentation for special enrollment periods before they can enroll in coverage. The proposed rule would also permit insurance companies to collect any missed premium payments before allowing consumers to re-enroll. Both of these changes could lead to gaps in coverage for consumers or deter enrollment.
Finally, the proposed rule would reduce the open enrollment period for individual and small group health insurance plans from 13 weeks to 6 weeks, which would give consumer significantly less time shop around for and enroll in the best plan for them.
Join members of New York City’s Congressional delegation, City officials, New York health care providers, advocacy groups and patients this Saturday morning at 11:00 AM at Gouverneur Health Auditorium, 227 Madison Street, on the Lower East Side of Manhattan to oppose efforts to dismantle the Affordable Care Act (ACA).
This rally comes on the same day that members of the House across the country are calling for a “National Day of Action” to oppose efforts to “Make America Sick Again.”
We hope to see you there!