House Begins to Consider a Bill to Repeal and Replace the Affordable Care Act

The House leadership has introduced a bill, the American Health Care Act, to repeal and replace the Affordable Care Act.  The bill replaces the ACA subsidies that help lower income people buy health insurance with a tax credit based on age that will help lower and middle income people buy insurance.  The funding for Medicaid expansion that has helped millions of low income people in 31 states access healthcare would be cut back significantly.  The essential health benefits requirements in some Medicaid plans, including for mental health care benefits, would be removed. 

The House plan does keep the popular provisions barring insurance companies from discriminating against people because of their preexisting conditions and forcing them to continue allowing young adults to stay on their parents’ plans until they’re 26.  It also does away with the individual mandate to purchase insurance and ends taxes on the wealthy that help pay for benefits.  Health Savings Accounts will be expanded too. 

The bill has not yet been analyzed by the Congressional Budget Office so there is no official cost for the plan, no determination of whether it will add to the federal deficit or lower it, and no official estimate of how many people will be affected.  Nonetheless, the relevant House committees are proceeding to consider and vote on the bill. (The bill is actually in two parts, being considered by two different committees.) It can be amended in committee and when the full House considers it. 

Estimates of the bill’s benefits for people at different ages and income levels versus the ACA can be found on an interactive map from the Kaiser Family Foundation.  Lower income people and older people fare worse in most scenarios than under the ACA. Results vary by state and county.  

The general approach of the Affordable Care Act was to transfer money from the wealthier and healthier to the poorer and sicker so they could afford health insurance.  The House bill turns some of that money around by ending tax increases on the wealthy, and by reducing Medicaid expenditures to pay for the new tax credits, and by making the credits available to people with higher incomes than ACA covered.  There is a legitimate national debate to be had about the role of the federal government in making health care affordable and available.  There will inevitably be winners and losers because healthcare is far from free.  That debate will take place in the next few weeks as the bill is considered in the House and sent to the Senate. 

The bill is constrained in what it does by restrictions on what can be included on a reconciliation bill.  Reconciliation bills are special budget-related bills that cannot be filibustered. Senate Democrats do not have enough votes to amend or defeat the bill by themselves.  

House and Senate Democrats are likely to vote against the House bill, as it is now written, as a block.  Four Republican Senators have signed a letter stating that they have serious concerns about the Medicaid cuts in the House bill, and mentioning the potential harm to mental health services that would result.  They are Senators Shelley Moore Capito of West Virginia, Cory Gardner of Colorado, Rob Portman of Ohio and Lisa Murkowski of Alaska.  If three Republicans join all the Democrats in opposing the eventual Senate bill, it will not pass.  At least three other Senate Republicans have expressed reservations that the House bill is still too generous, too expensive, and too intrusive.  A number of House Republicans and conservative groups have expressed the same reservations. 

The specific future of mental health benefit requirements is uncertain largely because many decisions would be left to the states. This article  goes into some detail on that.

It is still very early in the Congressional process.  Significant changes could be made, mostly by Republican members because they have the majorities.  Voting against the bill would be an act of courage on their part if they cannot support the final version.  The American Counseling Association will be working with coalitions to protect mental health benefits to the extent possible.  You can contact your legislators by going to Find Officials here