Following the Trail of the Affordable Care Act Debate: Part 6

By Zach Cahill and David White

Twenty-four million Americans will be left without health coverage if the American Health Care Act (AHCA) is signed into law. The Congressional Budget Office (CBO) reported this sobering number late Monday, March 13 – once again reshaping the landscape of the health care debate in Washington. 

Key Takeaways from CBO report

The CBO is a non-partisan organization whose primary mission is assessing the impact of legislation on the federal budget, debt, and deficits. Though it covered much more, the cost of changes to health insurance coverage was the most anticipated outcome of the report. The CBO estimated that repealing the Affordable Care Act’s (ACA) individual mandate (the requirement that everyone have health insurance) could drop the number of patients in the individual market by 14 million in 2018. 

AHCA proposes to end the ACA’s Medicaid expansion in 2020. As a result, the number of uninsured will rise to 21 million at that time. By 2026, AHCA will shrink the number of insured Americans by 24 million. 
Older Americans would be particularly hard hit by AHCA, according to the CBO. People between 50 and 64 will pay substantially more than they do today. For example, a person who earns 175% of the federal poverty level would pay insurance premiums under the AHCA of $14,600, compared to premiums of $1,700 under the ACA.

A small bright spot for Republicans, who are crafting this policy, is the deficit reductions projected by the CBO. Reducing the number of people on Medicaid roles could reduce the federal deficit by $337 billion between 2017 and 2026. 

Political ramifications of CBO report

The new CBO report did nothing to unite the disparate factions on Capitol Hill; in fact, it made the divide between the sides more stark. Republicans are still finding it difficult to unite their own party around a replacement plan. House leadership is assuming the Democrats will vote as a block in opposition and outreach to them has been minimal. As of Thursday, 37 House Republicans have expressed concerns with the AHCA.

The divide among Republicans on the Hill is between two camps. Moderates, such as Ileana Ros-Lehtinen (R-FL), are concerned about decreases in coverage with the AHCA. She tweeted after the CBO report was released “[a]s written the plan leaves too many from my [Southern Florida] district uninsured.” The Conservative faction is concerned that the tax credits of the AHCA are too generous and believe that the bill does not represent a full repeal of ‘Obamacare’. Members of this faction include ultra-conservative Freedom Caucus members, three of whom voted against the AHCA in the Budget Committee on Wednesday. It ultimately passed that Committee in a 19-17 vote and is now headed to the Rules Committee. 

Speaker Paul Ryan has consistently made the argument that significant changes cannot be made to the AHCA and members face a binary choice between the status quo of Obamacare and repealing that law with AHCA. During a Wednesday night press conference, the Speaker conceded that leadership would need to “incorporate feedback” from members and noted that “now that we have our score we can make some necessary improvements and refinements to the bill”. 

Path forward for AHCA

Any changes will be implemented when the AHCA makes its next stop in the Rules Committee next week. Even though the Speaker is now open to amendments, that does not mean the future of the bill is more certain. It is possible that amendments offered at this stage will favor one faction over another, exasperating the divide in both chambers.

With 21 Republican Senators now voicing concerns, the Senate remains the most significant obstacle to passage of the AHCA. Two Republican senators who we have not mentioned yet in this series are John Thune of South Dakota and Tom Cotton of Arkansas. Thune has expressed concerns about AHCA, particularly the fact that the legislation provides tax credits to everyone regardless of income. The wealthiest individuals would receive the same tax credits as the poorest ($2,000 for young adults and $4,000 for older adults).

Sen. Thune has discussed presenting an amendment that would increase tax credits for those with low incomes and ‘means test’ those tax credits, meaning that wealthier individuals would receive less support. Sen. Cotton has been vocal with his concerns about the whole house process, scoffing at the timeline presented by the House leadership and urging conservative House members to scrap the bill and start over.  

The CBO report this week is a reminder that this series, and the debate in Washington, is more than reporting on press conferences, white papers, and congressional hearings. At the end of the day the issues being debated on the Hill will impact kidney disease patients across the country. Despite continued opposition from stakeholders on and off the Hill, the AHCA marches forward. We will continue to bring you updates in this space.

Following the Trail of the Affordable Care Act Debate: Part 1, Part 2, Part 3, Part 4, Part 5

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Twenty-four million Americans will be left without health coverage if the American Health Care Act (AHCA) is signed into law. The Congressional Budget Office (CBO) reported this sobering number late Monday, March 13 – once again reshaping the landscape of the health care debate in Washington. 

Key Takeaways from CBO report

The CBO is a non-partisan organization whose primary mission is assessing the impact of legislation on the federal budget, debt, and deficits. Though it covered much more, the cost of changes to health insurance coverage was the most anticipated outcome of the report. The CBO estimated that repealing the Affordable Care Act’s (ACA) individual mandate (the requirement that everyone have health insurance) could drop the number of patients in the individual market by 14 million in 2018. 

AHCA proposes to end the ACA’s Medicaid expansion in 2020. As a result, the number of uninsured will rise to 21 million at that time. By 2026, AHCA will shrink the number of insured Americans by 24 million. 
Older Americans would be particularly hard hit by AHCA, according to the CBO. People between 50 and 64 will pay substantially more than they do today. For example, a person who earns 175% of the federal poverty level would pay insurance premiums under the AHCA of $14,600, compared to premiums of $1,700 under the ACA.

A small bright spot for Republicans, who are crafting this policy, is the deficit reductions projected by the CBO. Reducing the number of people on Medicaid roles could reduce the federal deficit by $337 billion between 2017 and 2026. 

Political ramifications of CBO report

The new CBO report did nothing to unite the disparate factions on Capitol Hill; in fact, it made the divide between the sides more stark. Republicans are still finding it difficult to unite their own party around a replacement plan. House leadership is assuming the Democrats will vote as a block in opposition and outreach to them has been minimal. As of Thursday, 37 House Republicans have expressed concerns with the AHCA.

The divide among Republicans on the Hill is between two camps. Moderates, such as Ileana Ros-Lehtinen (R-FL), are concerned about decreases in coverage with the AHCA. She tweeted after the CBO report was released “[a]s written the plan leaves too many from my [Southern Florida] district uninsured.” The Conservative faction is concerned that the tax credits of the AHCA are too generous and believe that the bill does not represent a full repeal of ‘Obamacare’. Members of this faction include ultra-conservative Freedom Caucus members, three of whom voted against the AHCA in the Budget Committee on Wednesday. It ultimately passed that Committee in a 19-17 vote and is now headed to the Rules Committee. 

Speaker Paul Ryan has consistently made the argument that significant changes cannot be made to the AHCA and members face a binary choice between the status quo of Obamacare and repealing that law with AHCA. During a Wednesday night press conference, the Speaker conceded that leadership would need to “incorporate feedback” from members and noted that “now that we have our score we can make some necessary improvements and refinements to the bill”. 

Path forward for AHCA

Any changes will be implemented when the AHCA makes its next stop in the Rules Committee next week. Even though the Speaker is now open to amendments, that does not mean the future of the bill is more certain. It is possible that amendments offered at this stage will favor one faction over another, exasperating the divide in both chambers.

With 21 Republican Senators now voicing concerns, the Senate remains the most significant obstacle to passage of the AHCA. Two Republican senators who we have not mentioned yet in this series are John Thune of South Dakota and Tom Cotton of Arkansas. Thune has expressed concerns about AHCA, particularly the fact that the legislation provides tax credits to everyone regardless of income. The wealthiest individuals would receive the same tax credits as the poorest ($2,000 for young adults and $4,000 for older adults).

Sen. Thune has discussed presenting an amendment that would increase tax credits for those with low incomes and ‘means test’ those tax credits, meaning that wealthier individuals would receive less support. Sen. Cotton has been vocal with his concerns about the whole house process, scoffing at the timeline presented by the House leadership and urging conservative House members to scrap the bill and start over.  

The CBO report this week is a reminder that this series, and the debate in Washington, is more than reporting on press conferences, white papers, and congressional hearings. At the end of the day the issues being debated on the Hill will impact kidney disease patients across the country. Despite continued opposition from stakeholders on and off the Hill, the AHCA marches forward. We will continue to bring you updates in this space.

Following the Trail of the Affordable Care Act Debate: Part 1, Part 2, Part 3, Part 4, Part 5

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