A visit to the homepage of healthcare.gov, the official site of the Affordable Care Act, makes no mention of its possible unraveling thanks to the American Health Care Act. The Republican counterproposal to the Affordable Care Act survived a House vote last week, and the bill must now face a vote of the Senate, and many believe the AHCA won’t become law without some major revisions.

Its House passage has been touted by many of Donald Trump’s supporters and the president himself as a huge victory. Much like the ACA’s Democratic party-line passage of the ACA in 2010, the AHCA passed without garnering a single Democrat’s vote, and it failed to convince 20 House Republicans (who also voted no) of the replacement’s merits.

Not long after the vote, state health care and business organizations began to weigh in on its passage.

“We have concerns that this bill will mean that many Coloradans will again be uninsured and reverse the progress that Colorado has made in providing both access and coverage to our residents,” said Steven Summer, Colorado Hospital Association president and CEO. “We applaud Congressman Mike Coffman, the lone Colorado Republican to vote against the bill in the House.”

Summer said the Senate is now responsible for addressing proposed cuts in Medicaid coverage and “that the House bill eliminates coverage for many essential conditions. The association has confidence that Sen. [Cory] Gardner, one of 13 Republicans developing a solution in the Senate, will work to ensure the progress in coverage Colorado has achieved is maintained and not eroded.”

Kevin Patterson, CEO of Connect for Health Colorado, the state’s health insurance marketplace, took a more measured approach.

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“I think it’s important to remember this vote is one step in a long process and the legislation is expected to change in the Senate,” Patterson said in a blog post. “Already, Republican senators are talking of writing their own bill. … Any changes in the Senate would have to go back to the House, so we are a long way from seeing the final direction of this legislation.

“We continue to work with our representatives at the state and federal level to protect the health coverage of all Coloradans and find solutions to the challenge of increasing access, affordability and choice,” he wrote.

Not all felt threatened by the House’s vote to repeal the ACA, however.

The National Federation of Independent Business issued a statement on behalf of President and CEO Juanita Duggan thanking members of the House for passing the AHCA.

“Passage of the American Health Care Act is a crucial first step toward health care reform that works for small business. It repeals many of the Obamacare taxes, repeals the mandates, and clears the way for additional reforms to make health care affordable, flexible, and predictable,” the statement said. “Small business owners have been waiting for repeal for many years. As predicted during NFIB’s landmark lawsuit to overturn Obamacare in the [U.S.] Supreme Court, our members’ costs have skyrocketed and choices for employers and employees were destroyed. Now that the House has kept its promise, we urge the Senate to pass the measure as soon as possible.

“The House must now address tax reform, another critical small business problem that has been neglected for decades,” the statement continued. “Small businesses need tax reform that creates parity between small and large corporations and reduces rates.”

As for the bill

If passed, the law would allow consumers to buy insurance outside of marketplaces created by the ACA and it does away with a requirement to purchase insurance or face tax fines.

“In place of that mandate, the bill encourages people to maintain coverage by prohibiting insurance companies from cutting them off or charging more for pre-existing conditions as long as their insurance doesn’t lapse. If coverage is interrupted for more than 63 days, however, insurers can charge people a 30 percent penalty over their premium for one year,” according to National Public Radio, which goes on to state, “The House plan would eliminate the income-based tax credits and subsidies available under the Affordable Care Act, replacing them with age-based tax credits ranging from $2,000 a year for people in their 20s to $4,000 a year for those older than 60.”

Medicaid patients would be one of the new law’s most impacted demographics. The GOP bill calls for the slow roll back of Medicaid expansion starting in 2019 by cutting federal reimbursement to states for anyone who leaves Medicaid enrollment. Due to the cyclical nature of Medicaid, the number utilizing the program is expected to grow smaller and smaller.

The law would also convert Medicaid from an entitlement program to a grant program.

The Congressional Budget Office, which conducts nonpartisan analyses for congressional economic and budget decisions, estimated two months ago that the bill would cut Medicaid by nearly $900 billion.

The AHCA would, as it’s currently written, continue to protect those with pre-existing conditions, but with exceptions.

Under the headline “Got a Pre-Existing Condition? Your Premium Could Rise Sharply Under New GOP Plan,” a Consumer Reports article said, “… a recent amendment to the AHCA, authored by House Republican Tom MacArthur … from New Jersey, provides a loophole. It allows states to let insurers charge higher premiums to sicker people if their coverage has lapsed, and if the state has set up a so-called ‘high-risk pool,’ or special health insurance programs for sicker patients.”

The article reports, “… critics say that even with that extra cash [the risk pools] those risk pools will be underfunded. And they point out that people with pre-existing conditions are especially likely to have gaps in insurance, because if they become too sick to work they may lose coverage through their employer…”

The bill would also eliminate taxes used to pay for ACA subsidies. The nearly $600 billion in cuts would include removing a tax on incomes over $200,000 (or $250,000 for a married couple); a tax on health insurers and a limit on what insurance companies are allowed to deduct for executive pay; as well as a tax on medical-device manufacturers.

The CBO found that older people with lower incomes would be AHCA’s most negatively impacted demographic.

As for state waivers, the bill would allow for optional, state-level repeals of the ACA and provide states the ability to opt out of many regulations and consumer protections included in the ACA. The waivers would allow insurance companies to charge older people more than five times what is charged to young people for the same policy; eliminate required coverage, called essential health benefits — including mental health access, maternity care and prescription drugs currently required under the ACA; and charge more for or deny coverage to people who have pre-existing conditions.

“The waivers could also impact people with employer-based insurance, because insurers could offer policies that have annual and lifetime benefit limits, which are banned under the Affordable Care Act, and some companies may choose those policies for their workers to lower premiums,” according to NPR.

House Republicans approved the bill May 4 without a full CBO analysis, but the office’s report in March of a failed, previous draft of the AHCA found that over the next decade, 24 million fewer people would be covered under the bill who otherwise would have had insurance under the ACA. The CBO also found that the AHCA could cut the federal deficit by $337 billion over that time.

Provisions in the new bill mean it is still unclear how changes would affect March’s CBO score.

A date has not been set for the Senate to vote on its version of the AHCA, with leadership stating a vote will happen when supporters are confident they have the 51 votes needed for its passage.

How Colorado reps voted on the American Health Care Act:

Ken Buck (R): Yes

Mike Coffman (R): No

Diana DeGette (D): No

Doug Lamborn (R):  Yes

Ed Perlmutter (D): No

Jared Polis (D): No

Scott Tipton (R): Yes


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