Health Care Questions: What's going on? And why?

Starting today and continuing through the week, the NCC Blog will attempt to answer some basic questions about the current health care debate, especially in relation to people with disabilities.

The first question is ...

"What's going on? And why?"

The American Health Care Act (AHCA) passed in the House on May 4, 2017. The Senate, under Republican leadership, is working on its own version of the bill. To become law, it must pass the Senate, then the two bills would have to be reconciled, passed again, and sent to President Trump to sign.

The House AHCA bill would do several things, all of which would affect health insurance in direct and indirect ways. The most important aspects for people with disabilities are:

• Capping Medicaid, which means making it a limited, budgeted program rather than an open-ended federal entitlement.

• Cutting Medicaid by over $880 billion in 10 years.

• Letting states allow insurance companies to charge higher rates to people with pre-existing conditions.

• Phasing out the Medicaid Expansion, which allowed people with slightly higher incomes to qualify.

• Ending the Community First Choice program which supports home and community based services.

There are several reasons why this is happening, including:

• The Affordable Care Act, (ACA, a.k.a.: Obamacare), was unpopular from the start. Despite reducing the uninsured rate to an historic low, the ACA has had recent problems with high premiums and lack of insurance providers in several states and regions.

• Obamacare is deeply despised in particular by Republican and conservative lawmakers, who view repealing it as top long term political goal, and a core promise they made to their voters.

• Conservatives generally oppose government involvement in health care on principle. Republican control of the House, Senate, and Presidency have created a rare opportunity to not only repeal Obamacare, but also to drastically cut back longstanding government health care programs like Medicaid.

• Although the two goals aren't formally connected, it's worth noting that if and when the AHCA is passed and made law, the Trump Administration's next big priority is to pass massive tax cuts, especially for higher income Americans.

In summary, the current debate is influenced by a combination of partisan political ambition, ideology, greed, and ... to some extent ... an genuine need to make health care better, more affordable, and more equitable.

Three more points:

• So far, the AHCA bill is very unpopular with the public, while the ACA ... Obamacare ... has become a good deal more popular after the November election, when President Trump's election made repeal more likely.

• The Congressional Budget Office, which analyzes the costs and benefits of all bills in Congress, estimates that the AHCA would result in 14 million fewer Americans having health insurance over 10 years, while the federal budget deficit would decrease by $337 billion.

• Senate Republican leadership hopes to pass the AHCA by July 4th, and is apparently bypassing the usual committee and hearing process, hoping to come to an agreement in secret, and get it passed quickly.

Tomorrow's health care question: What's the deal with "pre-existing conditions?"

Further reading:

We asked 8 Senate Republicans to explain what their health bill is trying to do
Tara Golshan, Dylan Scott, and Jeff Stein, Vox.com - June 16, 2017

Americans overwhelmingly like Obamacare more than Trumpcare
Bob Bryan, Business Insider - May 16, 2017

NCIL Statement on House Passage of the American Health Care Act
National Council on Independent Living - May 5, 2017

House Passes Health Care Bill Alarming Disability Advocates
Michelle Diament, Disability Scoop - May 4, 2017

American Health Care Act
Congressional Budget Office Report - March 13, 2017