The Affordable Care Act (ACA) reform legislation approved by the U.S. House of Representatives on May 4, 2017, by the narrow margin of 217 to 213 is expected to cause millions of Americans to lose their health insurance, make it much easier to eliminate essential health benefits and protections for people with preexisting conditions, and create instability for these protections in employer-sponsored health plans. Accordingly, ACEP’s Public Affairs team, working in conjunction with the Federal Government Affairs Committee and the Board of Directors, has shifted its focus to the Senate, where the fate of the American Health Care Act (AHCA) is much less certain.
Initial reactions by Republican senators have not been favorable to the AHCA, and not surprisingly, Democrats are unified in their opposition. Senate Majority Leader Mitch McConnell (R-KY) has the unenviable task of trying to craft a bill that can only lose the support of two Republicans from within a caucus of varying ideological beliefs about the ACA, its value to Americans, and whether it needs improvement or outright repeal. If Republicans fail to produce a plan that can be approved in the Senate and still have enough support to be passed in the House again within the next couple of months, the effort to modify the ACA, at least using the favorable procedural rules of budget reconciliation, will likely die.
On May 24, 2017, the Congressional Budget Office (CBO) released its updated analysis of the AHCA. According to the CBO estimate, the bill would result in 23 million more uninsured Americans over a decade while reducing the national deficit by $119 billion. Medicaid funding would be cut by $834 billion and cover 14 million fewer people. The AHCA repeals $664 billion in taxes and fees that currently finance the ACA. CBO also estimates that in states that do waive some of the “essential health benefits,” premiums would be 20 percent lower by 2026.