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With Millions Predicted to Lose Health Care, ACP Urges Senate to Craft a New Bill

House-passed bill would be 'terrible for patients,' College leader says

June 9, 2017 (ACP) -- The health care legislation passed by the House of Representatives to replace the Affordable Care Act would cause 23 million people to lose their insurance coverage over the next decade, according to an analysis by the nonpartisan Congressional Budget Office. That's a number that the American College of Physicians hopes will give the U.S. Senate pause as it considers a repeal-and-replacement bill of its own.

"The [CBO] report confirms all our fears about the devastating impact that the American Health Care Act would have on patient care," said Bob Doherty, ACP's senior vice president for governmental affairs and public policy.

In the wake of the CBO's analysis, released in late May, ACP continues to lobby the Senate to scrap the House-approved Republican plan and start over.

"Congress should move away from the fundamentally flawed and harmful policies that would result from the American Health Care Act as passed by the House," said Dr. Jack Ende, ACP's president. "We urge the Senate to reject this legislation."

The CBO's much-anticipated report came out in late May, after the House had already approved its plan to dismantle the ACA. The CBO had issued a similar analysis in March, but the House made changes to the bill that the CBO had analyzed and subsequently passed it without CBO review.

By contrast, Senate rules require the CBO to weigh in before senators can vote on the measure.

The CBO estimates that 51 million people younger than 65 would be uninsured in 2026 if the House-passed measure were to become law. That's 23 million people more than the 28 million currently uninsured.

The estimate varies only slightly from the 24 million Americans that the March CBO report predicted would lose insurance. "Some of those people would willingly lose their insurance, the CBO said, because they would no longer be required by law to have health insurance," The Washington Post reported. "Others, though, would unwillingly lose their insurance because they wouldn't be able to afford it."

The latest analysis also raises the prospect that consumers will pay much more out of pocket for insurance. People could face added jeopardy if they live in states that decide to reject "essential benefits" that the all insurers must now offer or the current prohibition against insurers charging more to people with pre-existing conditions.

The CBO projects that a sixth of the U.S. population live in states that would probably seek waivers from these requirements, with the result that coverage in those states would become unaffordable for people with pre-existing conditions. Also in these states, out-of-pocket costs would likely increase by thousands of dollars for prescription drugs, mental health and substance use disorder treatment and maternity care, according to the CBO.

It's true that premiums could fall for some people who live in states that waive essential benefits, Doherty said. But that's because some sicker people would leave the insurance system because of higher costs, he said.

Indeed, the CBO estimates that the annual premium on the individual market for a 64-year- old person making $26,500 would rise from $1,700 now to as much as $16,000 under the House-passed plan.

With the Republican-promised remake of health care now in the hands of the Senate, a group of about 13 senators are working to draft a new version of the bill.

"They're trying to come to a compromise," Doherty said. "But we're concerned that senators may choose to carry over 70 to 80 percent of the House bill. We hear they're considering capping the federal contribution to Medicaid and phasing out Medicaid expansion. The CBO found that capping and cutting Medicaid and ending funding for expansion, as the House bill would do, will result in 14 million of the most vulnerable patients losing coverage."

Just when the working group will release its bill and when the Senate will vote on it remain unclear. That could happen before the start of Congress's summer recess in early July, or it might not occur until fall.

"We're by no means out of the woods," Doherty said, "so we're being vigilant about why we think this could be terrible for patients."

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