3 Ways I Think the AHCA Could Affect Those With Pre-Existing Conditions


Editor’s note: This story reflects an individual’s experience and is not an endorsement from The Mighty. We believe in sharing a variety of perspectives from our community.

The Congressional Budget Office just released its report on the impact of the American Health Care Act (AHCA) in regards to the economic repercussions of the bill. The startling statistic that 23 million Americans will be uninsured under H.R. 1628 (the AHCA) by 2026 should be enough to convince both government officials and citizens alike that this “healthcare” act is dangerous and deadly to the most vulnerable Americans. Unfortunately, the projected reduction of the federal deficit by $119 billion is more than enough for some to take on the “if it doesn’t impact me, it doesn’t matter” attitude, cheering on the success of the AHCA.

But how could this bill affect those who are chronically ill specifically? There are three essential parts I think warrant your attention:

1. The deficit reduction relies on drastic cuts to Medicaid. $834 billion of the Medicaid budget will be slashed, terminating enhanced federal matching funds and putting a per capita-based cap on Medicaid payments. Medicaid is funded jointly by the federal government and the states, meaning the program will be dismantled by both ends. Medicaid is a public insurance program that provides health coverage to low-income families and individuals, including children, parents, pregnant women, seniors and people with disabilities. Though most people with chronic illnesses rely on Medicare, which is a different program than Medicaid, there are still many disabled people who do receive Medicaid benefits.

2. If states choose to modify their Essential Health Benefits, these EHBs might no longer include some forms of basic care like maternity care and might exclude some benefits that would increase out-of-pocket payments (such as for expensive prescription drugs) – especially for those complicated and costly health issues requiring more than a primary care physician. Services and benefits that are likely to be excluded from the EHBs in most states include, but are not limited to: maternity care, mental health care, substance abuse benefits and rehabilitative and habilitative services. This could leave what is included under EHBs bare-boned and insufficient. If those simple benefits are not included, then it is questionable whether specialized testing, vital procedures and other life-sustaining care that chronically ill Americans rely on will be required to be covered under any insurance plan.

3. The MacArthur Amendment and the Upton Amendment might not adequately protect people with pre-existing conditions. The CBO report states, “the ACA’s ban on annual and lifetime limits on covered benefits would no longer apply to health benefits not defined as essential in a state. As a result, for some benefits that might be removed from a state’s definition of EHBs but might not be excluded from insurance coverage altogether, some enrollees could see large increased in out-of-pocket spending because of annual or lifetime limits would be allowed.” The most damaging part of the CBO report is:

“People who are less healthy (including those with preexisting or newly acquired medical conditions) would ultimately be unable to purchase comprehensive nongroup health insurance at premiums comparable to those under current law [ACA], if they could purchase it at all – despite the additional funding that would be available under the H.R. 1628 [AHCA] to help reduce premiums. As a result, the nongroup markets in those states would become unstable for people with higher-than-average expected health care costs.”

Basically, chronically ill Americans who live in states that apply for waivers from key ACA required provisions – most notably the requirements to charge healthy and sick people at the same prices and cover a set of EHBs – are at risk. Speaker Ryan would like you to believe the AHCA will achieve lower premiums and a lower deficit, and he’s partly right – but it’s at the expense of those with preexisting conditions. It achieves these goals by breaking the promise to protect those with preexisting conditions. Lower premiums will be available to healthy people because sick Americans will drop out of the insurance marketplace.

It’s not too late to make your voice heard. Call your local Senators and let them know how the passage of this healthcare bill affects you, a loved one or even your fellow Americans. Don’t let our country regress, leaving millions of vulnerable Americans uninsured. It doesn’t matter if you’re a Republican, a Democrat or an Independent – pain isn’t partisan.

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Thinkstock photo via dkfielding.


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