Let’s be clear, rather than a compromise, the new version of the American Health Care Act (AHCA) makes a deeply harmful plan even more destructive.
The original proposal, the House’s plan to repeal and replace Obamacare, failed in part because some members were rightly worried about 24 million people losing health coverage, as projected by the Congressional Budget Office. The so-called “Meadows-MacArthur amendment” is the only change in Congress’ second attempt. This new version keeps all of the damaging components of the first bill while threatening coverage for even more Americans by scrapping protections for people with pre-existing conditions.
There are an estimated 1.8 million Kentuckians who have some form of pre-existing condition. The bill would give states the option of basing premiums on the health status of each person, resulting in skyrocketing premiums for many individuals. The Center for American Progress estimated the added annual cost of premiums in Kentucky for several conditions:
- Asthma: $3,920
- Diabetes: $5,060
- Major depression: $7,680
- Pregnancy: $15,660
- Breast Cancer: $25,930
Most people can’t afford additional five digit premium costs, so the end result will be that the people who need care the most will be left without insurance. To address this problem, states could provide high risk pools that in theory would provide coverage to uninsurable residents. But Kentucky has tried that idea before. The state’s old high risk pool covered only 4,700 people at its peak, the premiums were nearly double those of comparable plans and for the first year an individual was enrolled it didn’t even pay for care related to the conditions that made coverage unaffordable.
Let’s not forget, either, that this bill still effectively eliminates expanded Medicaid. Around 470,000 Kentuckians are covered through the Medicaid expansion. That program has greatly helped hospitals and providers, contributed to 13,000 new healthcare sector jobs and is already improving health by some measures. Ending the expansion would not only reverse our nation-leading healthcare gains, but stripping $3.5 billion in funding out of our economy could result in 80,000 fewer jobs by 2022 according to the Economic Policy Institute. About 20,000 of those jobs would come from eastern Kentucky’s 5th Congressional District, a figure higher than any other district in the country according to the report.
In addition to those who will lose coverage because of the end of Medicaid expansion, there are close to one million other Kentuckians enrolled in traditional Medicaid who are under the gun of the AHCA. The bill reaches past the Affordable Care Act and fundamentally restructures how Medicaid is paid for, resulting in a permanent squeeze on federal funds for the program. That will force Kentucky to shoulder a $16 billion cost shift over 10 years, resulting in lawmakers having to decide about rationing care, cutting benefits or reducing payments to healthcare providers.
Also still in the bill are cuts to the assistance in paying insurance premiums and other costs provided under the Affordable Care Act. These cuts would result in a $1,804 increase in out-of-pocket costs for the average Kentuckian purchasing insurance on Healthcare.gov. For older and low-income Kentuckians this change is even worse. For example, a 60 year old Kentuckian earning $22,000 a year would see her premium rise $6,266 – eating up an additional 28 percent of her annual income.
Kentucky’s six House members come from a state that, in many ways, has the most to lose from the AHCA. The latest iteration of that bill is an even worse version of the first – a radical and dangerous departure from health progress we’ve experienced over the past several years. All Kentuckians are better off when our neighbors are healthier and more financially secure. If Congress move forward with this bill, we will all pay the price.
This column originally ran in the Courier-Journal on May 2, 2017. It ran in the Lexington Herald-Leader on May 3, 2017.