Note: the AHCA has undergone several amendments since this blog. For the updated analysis, check our our new blog post on the AHCA.
This week, the Republicans released their long-awaited replacement plan for the Affordable Care Act (ACA) as the American Health Care Act (AHCA) was introduced in the House. After last year’s election, we released a statement entitled “Preserve the Protections Provided by the Affordable Care Act” where we called on Congress and the Trump Administration to protect provisions in the ACA which have been a benefit to people with disabilities. (To read the NDNRC statement, click here.) In that statement, we outline eight core principles that we believe need to be part of any ACA replacement. How the AHCA would affect these eight principles is as follows:
- Prohibition against Denial of Coverage for Pre-Existing Conditions: The AHCA maintains the ACA protection that insurance companies cannot deny coverage due to a pre-existing conditions.
- Guaranteed Renewability of Coverage: The AHCA maintains the ACA protection that insurance companies must renew anyone’s coverage.
- Prohibition against Individual Underwriting: The AHCA maintains the ACA protection that insurance companies cannot set someone’s premiums based on disability or health conditions.
- Essential Health Benefits Required in Every Qualified Health Plan: The AHCA maintains the ACA requirement that every health plan must cover 10 essential health benefits for plans offered on the exchange. However, the AHCA does eliminate the essential health benefits for the Medicaid program.
- Prohibition against Lifetime Monetary Caps: The AHCA maintains the ACA protection which prohibits insurance companies from placing lifetime or annual monetary caps on the amount they will reimburse for care.
- Prohibition against Discrimination in Health Programs: The AHCA keeps §1557 which prohibits discrimination in any health programs on the basis of race, nationality, disability, age, or sex.
- Extension of Mental Health Parity to the Individual and Small Group Market: The AHCA does not change the mental health parity law so it will continue to apply equally to the employer and large group markets as well as the individual and small group markets.
- Medicaid Expansion: Under the AHCA, the Medicaid expansion would remain in effect through 2019, but beginning in 2020 the Medicaid program as a whole would transfer to a per capita cap. The per capita cap would mean that the federal government would pay a set amount per enrollee to the states. We believe this would significantly undermine the Medicaid program and would most likely lead to reduced access to care for people with disabilities on Medicaid. AAHD is a member of the Consortium for Citizens with Disabilities (CCD) and CCD has put out a statement indicating how detrimental both block grants and per capita caps could be on people with disabilities. That CCD statement can be downloaded here.
While it was not included in our original eight principles and is not specifically related to disability, there is another change is that the AHCA would make that is problematic. The AHCA dramatically changes the structure of the premium tax credits so that the amount of the tax credit would be determined by age as opposed to income level. If you want to see more about how those tax credits would be calculated, check out our news item from earlier this week where we highlight some of the resources from the Kaiser Family Foundation. That news item is available here. Many times people with disabilities earn less so having a premium tax credit which is tied to income is more beneficial for those individuals. We believe the structure set forth in the AHCA would result in health insurance premiums that would not be subsidized enough for low income individuals to be able to afford insurance and this could especially have a disproportionate effect on people with disabilities.
In total, the AHCA does preserve a lot of the protections that were part of the ACA, but it does so at a very heavy cost. The AHCA is extremely complex and this analysis only reflects a review of the eight principles for people with disabilities that the NDNRC created. Given the drastic changes the AHCA makes to the Medicaid program, the American Association on Health and Disability (the lead partner for the NDNRC) opposes the AHCA and urges Congress to reject it. For more information on what the AHCA would mean for people with disabilities, check out some of these resources:
- Disability Rights Education and Defense Fund: DREDF Statement on AHCA
- NAMI: New Bill Puts Mental Health Coverage at Risk
- The Arc: How will Medicaid Block Grants Impact People with Intellectual and Developmental Disabilities and their Families?
- The Arc: Statement on AHCA