The American Health Care Act and its Effects on Healthcare

Repeal and replace has been the ongoing motto of the current administration with regards to the Affordable Care Act. Repealing has remained the easy task, but replacing is the hard part, the one filled with frustration of a system that is can swallow you whole.


While the Affordable Care Act is not without its shortcomings, it was a success in several ways. Mark Hall, JD, one of the leading scholars in the areas of health care law and public policy at Wake Forest University, made three clear points about the ACA at a town hall in Winter 2017: 1) it was never written to provide universal coverage; 2) most Americans have no idea that the uninsured rate is the lowest in decades; 3) the insurance laws were changed so that no one was uninsurable.


However, the American Health Care Act (AHCA), the replacement for the ACA, seems less likely a repeal and replace, and more like a repeal with no clear strategies to on improvement. And when it comes to health and lives of millions of Americans, an inadequate replacement is not good enough.


Source: Wikipedia

The House Energy and Commerce and Ways and Means committees initially introduced the AHCA in March 2017, where it failed to pass. This bill as it stood in March would have repealed tax penalties for those without insurance, reduced Medicaid spending, incentivized states to stop Medicaid expansion, and would have cut off federal funds to Planned Parenthood for a year. The Congressional Budget Office estimated that 24 million more people would be uninsured by 2026 under the AHCA. The CBO has not updated its estimate since the new version of the bill narrowly passed the House.


What does that really mean for those of us who are not policy savvy?


For one, AHCA would reduce the funding for subsidies the ACA provides to people seeking health insurance through the marketplace plans. Older people would have greater premiums than younger people.


Also, the bill also provides tax cuts, including those on health insurers and higher income people. These ACA imposed these taxes to pay for its provisions.


AHCA does not eliminate the requirement that Americans should be insured, but it would get rid of the penalties imposed.


States could obtain a waiver from the Department of Health and Human Services Department so they could charge customers with preexisting conditions more than other people. While the bill does specifically say what preexisting conditions would meet the criteria, pre-ACA, several insurers had included the following as preexisting conditions: domestic violence, sexual assault, Caesarean section, and post-partum depression. These preexisting conditions disproportionally affected women and were grounds for either denying coverage or charging higher premiums pre-ACA.


Young adults will still be able to remain on family insurance plans until age 26, a component of ACA that has been popular across party lines and in the American public.


AHCA would result in an $880 billion Medicaid cut over the next decade. This program provides health coverage for low-income Americans and helps pay for long-term care for people with disabilities and seniors.


AHCA would cut funds for public health programs, starting in 2018, including programming for vaccine-preventable disease, hospital acquired infections, and immunization registries, infrastructure, and delivery.


Over 20 healthcare organizations and professional groups including the American Academy of Pediatrics, the American Association of Medical Colleges, the American Medical Association, the American Heart Association, and the American Congress of Obstetricians and Gynecologists have spoken out against the bill.


Leading surgeon, health policy expert, and writer, Atul Gawande in an ABC interview with George Stephanopoulos argued against the bill as a step back, not forward.


“Here’s the thing to understand is that this is not — this is a bill that makes each measure of health and health care worse, rather than better than under Obamacare. It’s not a proposal that anybody would put forward as a credible or sane proposal for solving the problems in Obamacare,” Gawande said.


The bill has to still undergo an extensive review process and will likely change in the Senate before it ever makes it to the floor. However, if AHCA is passed and implemented as it stands, it poses serious issues and questions for health care providers, especially those of us entering the health care workforce when the provisions would be implemented. These provisions have serious implications for all of our patients, our institutions, and community partners and for federal, state, and local health programming.

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Vaidehi Mujumdar

Vaidehi Mujumdar is a medical student at Wake Forest School of Medicine. An alumna of Dartmouth College, her writing has been published in The Guardian, The Almost Doctors Channel, The Intima: A Journal of Narrative Medicine, US Edition, Media Diversified, and others. Follow her on Twitter @VeeMuj.