ACA ‘Repeal and Replace’ Bill Unveiled

Repeal and Replace BilLate yesterday evening, a bill was introduced in Congress to repeal and replace the
Patient Protection and Affordable Care Act (ACA or Obamacare).  Prior to the actual introduction of this piece of legislation, there was a lot of speculation about what would be included, and although a version was just released, the House of Representatives is expected to begin considering the legislation in the relevant committees this week.  This is very fast moving compared with other legislation.

The bill is significantly shorter than the ACA and has been named “The American Health Care Act.”

If passed, the law would make several significant changes to our health care system.  For example, the bill would:

  • Eliminate the current requirement that most Americans have health insurance or pay a penalty.
  • Eliminate the current requirement for large employers (50+ employees) to pay a penalty if they do not provide adequate and affordable health insurance to their employees.
  • Require that people have “continuous coverage” or else they could be charged a 30% higher premium. Starting with open enrollment for 2019 insurance plans, anyone who has gone more than 63 days without coverage during the previous 12 months will be assessed a 30% late-enrollment surcharge on top of their base premium.
  • Eliminate the current system of financial assistance to purchase individual health insurance that is based on income and household size. Instead the law would provide tax credits based on age, rather than income. Those under 30 would receive $2,000 per year, up to those over 60, who would receive $4,000 per year. Only individuals earning up to $75,000 a year and married couples filing jointly earning up to $150,000 a year for would be eligible for the full credit. It is estimated that many people currently receiving financial assistance would see a 50% cut in the assistance that they receive under this new law.
  • Change the funding structure of the Medicaid system (i.e., to a per capita payment). This means that each state will receive a set amount of money each year. If states run out of money during the year, they will either have to limit enrollment, limit coverage, or both. This system might end up looking like the failed High Risk Pool structure we had prior to the ACA.
  • Increases the amount that insurance companies can charge older Americans for their health insurance from a 3:1 ratio to 5:1 ratio. Currently, insurance companies cannot charge a 64 year old more than 3 times what it charges a 21 year old. This bill would change that to 5 times what a 21 year old is charged, making health care that much more expensive for older Americans.
  • Eliminate several of the taxes (e.g., the medical device tax, the tanning tax, a tax on high earners, etc.) created by the ACA that were designed to help pay for the financial assistance provisions and expansion of coverage.

The bill does not repeal the protections for people with pre-existing conditions and allowing young adults to stay on their parent’s policy until they turn 26, but also doesn’t address some of the gaps in coverage. For example, the bill does not address the cost of prescription drugs or how much insurance companies can increase rates year to year.

So, while some protections from the ACA will survive, it is anticipated that if this bill passes, many of the 20 million Americans that gained coverage under the ACA will be negatively impacted. For the cancer community, passage of this bill could mean an increased likelihood of facing financial ruin due to a diagnosis.

Of course very few bills are ever passed exactly as they are introduced, so there will still likely be more changes.  Additionally, even if this bill is passed by the House of Representatives, it still has to pass the Senate, and be signed by the President.

Stay tuned for more updates.

What You Can Do

We will have to continue to wait and see what happens, but in the meantime, there is something that you can do.

  1. Share your experience and concerns: Call or email your elected officials and share your health insurance concerns. To find your elected officials or learn more about becoming an advocate, visit our Advocacy resources page. You can also find the Facebook and Twitter handles for the current members of Congress here.
  2. Tell your story: Share your story with Families USA or the National Coalition of Cancer Survivorship (NCCS), two health care advocacy organizations that are working to help our elected officials understand the dire consequences of repealing the ACA and how certain changes to our health care system can impact us all. But they need the stories of real people. If you feel comfortable doing so, you can share your story at at org/blog/share-your-aca-story.

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