In recent days, Republicans in the U.S. House of Representatives finally released and started “marking up” their long-promised and long-hidden bill to repeal and replace the Affordable Care Act (ACA). Ever since the transformative health care law was enacted, opponents of the ACA have tried to repeal it more than 60 times. Throughout the 2016 presidential campaign, Donald Trump vowed to “… repeal it, replace it, get something great!” Now, they appear poised to actually make good on their threat.
A quick review of the new proposal reveals several enormous flaws. Despite the claims of proponents, for instance, the proposal doesn’t really “replace” the existing law. In a host of ways, millions of average Americans who benefited from the ACA will simply be left out in the cold.
Amazingly, however, this may not be the worst part of the new proposal. You see, now that the GOP controls the U.S. House, Senate, and the Oval Office, its leaders are reaching beyond mere ACA repeal and replacement and are working to undo decades of progress in programs that help low-income Americans. In fact, the 66-page American Health Care Act (or AHCA, as the GOP bill has been dubbed) includes provisions that would do terrible damage to Medicaid, the nation’s health care system for people in need.
One section would impose something called a “per capita cap” model. What this means, in simple terms, is that states like North Carolina would see a big cut in federal dollars. Rather than getting reimbursed based on the health needs of each covered individual, states would simply receive a rigid allotment from the federal government based on nothing but the number of people served. The individual needs of patients would be irrelevant. Indeed, the proposal would base the allotments on funding for fiscal year 2016.
Thus if a Medicaid beneficiary needs care beyond the fixed amount, North Carolina would have to find the additional funding in state funds to cover an individual’s health care needs or simply not provide coverage. Especially as health care costs continue to rise faster than overall inflation, such a change to arbitrary caps will likely prove disastrous for state budget makers over time.
So what is the excuse for such a radical shift?
According to supporters of the proposal, restructuring Medicaid will put the safety net program “on a budget” and “give states more flexibility.”
The truth of the matter, however, is that all states, including North Carolina, have long enjoyed lots of flexibility and have regularly obtained “Medicaid waivers” from the feds to make use of it. What’s being proposed in the ACHA is the dubious “flexibility” to take on more risks.
And remember; once the cap is exhausted, states are on the hook for 100% of costs. As per capita caps fail to keep up with beneficiaries’ health care needs and costs, states will either have to use more of their own funds or make cuts to the program. The cuts will then impact the lives of the most vulnerable – the aged, blind, people with disabilities, low income pregnant women, and infants and children. These are the people who will be at risk as state lawmakers wrestle with cuts in federal funding.
Faced with built-in funding shortfalls, states will be forced to decide which Medicaid services to cut. Will people with disabilities still receive the services and supports they need to live at home? Will low income older adults still be able to receive care in nursing homes? Will pregnant moms get much needed prenatal care to birth a healthy baby? Will children living in poverty get the screenings, diagnostics, and testing they need to prevent health problems so that they can reach their full potential?
Sadly, what really seems to be at work here is a conservative ideological determination to decimate one of the nation’s most vitally important social safety net programs. Though they often pay lip service to the notion that those struggling in society in need to “have skin in the game,” conservatives do not seem to understand that without basic health care, most people have no chance of participating in the game at all.
Throughout last year’s presidential campaign and in the weeks since he took office, Donald Trump has promised “insurance for everybody.” Unfortunately, the AHCA not only erases the coverage gains as a result of the ACA, but it will place state budgets across the nation and the lives of millions of people (including 1.9 million North Carolinians) at tremendous risk.
And there’s nothing “great” about that at all.
Ciara Zachary is a Policy Analyst at the North Carolina Justice Center’s Health Advocacy Project.