Spotlight Exclusives

Bipartisan Concerns about the AHCA

Spotlight Staff Spotlight Staff, posted on


Poverty advocates and health care experts in both parties expressed concern about the health care bill passed Thursday by the House of Representatives and urged the Senate to address provisions that would diminish coverage for low-income Americans.

Conservatives raised questions about the bill’s impact on the Affordable Care Act’s expansion of Medicaid and whether the House action was more political than substantive. On the left, advocates urged Senate action to restore potential cuts to health care access for the poor.

“Thursday’s House vote to repeal and replace portions of the Affordable Care Act is more of a narrow political victory for Republicans than a long-term policy solution to many of the problems of that law,” American Enterprise Institute resident scholar Thomas P. Miller told Spotlight.

“The (American Health Care Act) would dramatically increase the number of people who are uninsured, make coverage less comprehensive and more expensive, and slash hundreds of billions of dollars from the Medicaid program,” said Olivia Golden, executive director of the Center on Law and Social Policy. “At the same time, the bill would provide billions in tax cuts to the wealthy.”

The bill, passed by a 217-213 vote, includes a number of policy changes that would directly impact low-income families and individuals. The bill would:

  • Defund Planned Parenthood for one year
  • Allow older Americans to be charged more: Under the Affordable Care Act, insurers can’t charge a 64-year-old more than three times as much as it does a 21-year-old. The House plan would let insurers charge older customers five times as much. And in states that waive that rule, insurers could establish an even higher ratio.
  • Cut basic benefits: The bill also allows states to seek a waiver to eliminate benefits required by the ACA such as maternity and mental health care.
  • End coverage for those with pre-existing conditions: Waivers also would be available to states to end the ACA’s guarantee of coverage for some applicants with pre-existing conditions.
  • Diminish Medicaid coverage: The Republican plan would begin rolling back the Medicaid expansion provided by the ACA in 2019. It would also convert Medicaid from an entitlement program, in which the government pays all health-related costs, to a grant program. The federal government would give states either a set amount of money for each Medicaid enrollee or let them choose to receive a fixed-dollar block grant. The Congressional Budget Office estimated in March that the bill would cut Medicaid spending by $880 billion.

AEI’s Miller said the House bill offered some benefits for low-income Americans. “If enacted into law, the bill means that most low-income Americans would be subsidized less generously for insurance coverage either under Medicaid or the ACA’s individual market exchanges, but they could expect to find a wider range of lower-cost insurance options: stronger incentives to work more, earn higher incomes, and maintain continuous insurance coverage; effective protection against the risk of developing high-cost medical conditions; and the opportunity to target their own resources toward what they value most.”

However, a March analysis by the Tax Policy Center of the Urban Institute and Brookings Institution of the initial American Health Care Act drafted by House Republicans indicated it would adversely impact low-income Americans overall. The study found that those making less than $10,000 per year would lose an average of about $1,400, or nearly one-third of their income, under the AHCA. Middle-income households, those making $50,000 to $75,000, would see little change – an average increase in net government transfers of about $60. However, those making $200,000 or more would receive an average net increase in government support of $5,640, or 1.1 percent of their income.

“I have been in Washington, D.C. for 45 years.  But I have never seen members of Congress vote to so deeply hurt so many of their own constituents,” said Robert Greenstein, president of the Center on Budget and Policy Priorities. “If enacted, this bill will stand as the biggest assault on ordinary Americans — and the largest Robin-Hood-in-reverse transfer of income up the income scale, from low- and middle-income families to those at the top — in our country’s modern history.”

Senators from both parties indicated their version of the House measure would bring significant changes. On provisions that particularly impact low-income Americans, senators seemed concerned about the ACHA’s potential Medicaid cuts.

“I continue to believe that the House bill does not adequately protect Ohio’s Medicaid expansion population,” Ohio Sen. Rob Portman (R) tweeted shortly after the House vote.


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