FEB 17, 2017
A month after rushing through a budget resolution that would allow them to repeal the Affordable Care Act (ACA) with a simple majority vote, Congressional Republicans have yet to introduce legislation that would do so. However, this week House leadership released the outline for a proposal they may consider after next week’s recess. Most of the elements of the proposal are similar to what Republicans—including newly confirmed HHS Secretary Tom Price—have previously suggested, and that independent analyses have shown would cover far fewer people than the ACA. However, this outline goes further than before in making clear that they intend not merely to undo the expansion of insurance under the ACA, but also to destroy the very fundamental structure of Medicaid that has provided affordable health care to low-income children, parents, seniors and individuals with disabilities since 1965.
Medicaid lifts people out of poverty, improves children’s performance in schools, and keeps people healthy so they can maintain employment. It’s a solidly performing program that supports those most in need when they encounter struggles in life.
Should this latest proposal out of Washington be implemented, it would eliminate Medicaid’s guarantee of affordable health care for low-income families and seniors. Instead of the ongoing Federal commitment to sharing in the costs of providing comprehensive coverage to eligible families, states would receive capped funding for Medicaid—in the form of block grants or “per capita caps”—that would shift costs and hard choices to states, and likely end up with states rationing care. This is exactly what has happened in other block grant programs; because the funding for Temporary Assistance for Needy Families (TANF) and the Child Care and Development Block Grant (CCDBG) has failed to keep up with need, states have restricted access and cut payments to families and providers under these programs. Under this proposal, those who are most vulnerable and falling on hard times would no longer be assured of receiving needed health care to save their life or keep them healthy enough to work.
With respect to the more than 10 million people in 31 states and the District of Columbia who have gained coverage through Medicaid’s expansion under the ACA, the newest proposal seriously jeopardizes their coverage. The proposal claims to not “pull the rug” out from under people, but outlines a plan to significantly reduce federal payments to states for this population, forcing states to pick up a much larger share of the costs or backing them into a corner to cut eligibility and/or benefits.
The proposal assumes that many people covered by Medicaid will transition to other insurance. But, let’s remember who is in this population—it’s hard-working Americans, often holding down multiple part-time jobs or minimum wage jobs for employers that simply don’t offer health insurance, and buying insurance on the private market is prohibitively expensive. This population will have the rug pulled out from them—it will happen after the next election cycle and the states will be the ones making the immediate choices, perhaps taking the political heat.
For those who purchase insurance on the private market, the proposal includes providing tax credits to help people purchase coverage, similar to the ACA. However, unlike the ACA, the tax credits proposed by Republican leadership in Congress are not based on income, so low- and moderate-income households would likely experience a large and growing gap between the cost of comprehensive coverage and the value of the credit. As a result, many people will either not buy coverage because it’s too expensive, or they will buy coverage that may be too minimal to actually help them afford care. Lastly, there is no mention of helping people reduce their out-of-pocket costs by reducing co-payments or deductibles like the ACA does through cost-sharing reductions. Meanwhile, high-income, self-employed workers would receive increased tax credits and access to tax-preferred savings accounts, something that is meaningless to low-income workers who often have minimal tax liability and little ability to save.
Despite record high approval ratings of the ACA, Congress continues to push for repealing the popular law, reducing assistance for low-and moderate income working families, shredding the safety net for the most vulnerable, while giving large tax cuts and credits to high-income households. If enacted, this would be devastating to poor children and seniors, as well as hard-working Americans who are employed in jobs that don’t often provide health insurance, such as retail, restaurants, or child care. Next week, Congress will be out of session and most members will be in their home states. It is a critical time for constituents to speak to their members of Congress about the impact that ACA coverage and Medicaid have on their families and communities, and tell them to protect our care.
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