Resources from around the coalition: The health care edition


June 16, 2017

Editor’s note: The following blog post is authored by CHN intern Raquel Douglas.
3 million children without insurance. Medicaid cut by almost 50 percent. $1.2 billion in cuts to the Centers for Disease Control and Prevention. 23 million people at risk of losing access to affordable health care coverage. Systematic discrimination against the elderly, sick, and disabled.

The Trump budget proposal, the House-approved American Health Care Act (AHCA), and the Senate’s anticipated version of a health care bill all feature draconian cuts to the health care safety nets that are vital for so many. Each significantly weaken the protections that many vulnerable populations gained in the Affordable Care Act (ACA), reverse the recent Medicaid expansion, and threaten the coverage for millions. Children, women, elderly people, those with disabilities, and Americans as a whole are negatively impacted by these proposed changes. We have compiled a plethora of informative and relevant resources from around the Coalition on Human Needs below on how each of these 3 proposals affects our health care system.

Last month, First Focus released an incredibly detailed fact sheet on the Trump budget’s nearly across-the-board slashes to programs that are vital to the health of children. Though 38 million children rely on Medicaid for health coverage, the proposal asks for deep cuts to Medicaid (up to $1.5 trillion over the next decade when combined with current pending cuts in Congress) and CHIP ($5.8 billion annually). Many other programs that have a direct, positive impact on the health of children are similarly devastated by the Trump budget. The Centers for Disease Control and Prevention is cut $1.2 billion, including cuts to the National Center on Birth Defects and Developmental Diseases, the National Center for Immunization and Respiratory Diseases, and the National Asthma Control Program. The Emergency Medical Services for Children, the Autism and Other Developmental Disorders, and the Universal Newborn Screening programs are all eliminated in the new budget proposal.

If you’re looking for a breakdown of exactly why the per capita caps to Medicaid matter, Families USA provides just that in their new blog post. The cuts, which are veiled behind ACA repeals, combined with reductions to Medicaid in the House repeal’s bill, eventually could downsize Medicaid by almost 50 percent. In addition, the caps would increase every year by a measure that inaccurately underestimates the growth rate in medical care over the next decade by 1.3 percent relative to the CBO estimate. The caps arbitrarily lock states into their 2016 Medicaid spending level, fail to take into account the increasing medical costs for the aging Baby Boomers, and provide new ways for the federal government to cut Medicaid in the future. In short, these caps are a pretty big deal.

These per-capita caps, along with the repeal of the Medicaid expansion, the elimination of the federal match for states that use the Community First Choice Option, and the repeal of the requirement that certain insurers cover essential medical benefits ensure that the AHCA will be devastating to people with disabilities, according to The ARC. The AHCA additionally would allow insurers to charge the elderly more for insurance, eliminate the three-month retroactive coverage requirement, and change the mandatory Medicaid income eligibility level back to 100 percent below the federal poverty level. For a more comprehensive reading of the effects of the AHCA on those with disabilities, read The ARC report here.

The Center on Budget and Policy Priorities makes it easy to sort through the differences between the House and the Senate’s proposed versions of the AHCA with their new tracker. This tracker analyzes what the House bill proposes, reported changes that the Senate is making, and the long term impact of those reported changes for Medicaid expansion and per capita cap, the individual market, state grants, consumer protections and tax cuts. For example, the House bill will reverse the ACA’s Medicaid expansion, which allowed more than 11 million low-income adults to gain coverage in 2020. The Senate bill might reverse the Medicaid expansion over a seven-year period that begins in 2020. In the long run, however, these have the same effect of reversing the ACA’s Medicaid expansion and threatening the access of affordable health care for more than 11 million people.

A thorough analysis of the effects of the health care bill passed by the House on uninsured rates on various age groups and poverty levels can be found in a report published last week by the CBPP. The stats are chilling—an estimated 23 million people from all age and income groups would lose health insurance under this bill, reversing healthcare coverage gains. Almost 3 million children, 6.4 million young adults, 8.2 million middle-aged adults, and 5.1 million older adults would lose coverage. 14.7 million adults with incomes below 200 percent of the federal poverty line would lose insurance, as would 5.1 million adults above that marker. All groups therefore experience lower rates of insurance under this proposed health care bill.

The Center for American Progress analyzes the anticipated Senate health care bill, especially in relation to its effects on people with pre-existing conditions. One potential cause for celebration is the speculation that the Senate bill will not include the House bill’s provision that would allow insurers to charge the sick and disabled higher premiums than healthy and able-bodied people. Unfortunately, the Senate bill will likely allow states to waive EHB standards, which require that insurers cover a whole range of medical benefits, from mental health, maternity care, hospitalizations, and prescription drugs, weakens the ACA’s ban on dollar limits on coverage, and ultimately still allows insurers to systematically discriminate against sick and disabled people. The “age tax” and rollback of the Medicaid expansion will only make these worse.

The National Women’s Law Center provides an extensive fact sheet that analyzes the individual state level effects of ACA repeal on women and women of color as well as historical data about the state level health care coverage of these groups. For example, 7.8 million women and 5.1 million women of color gained health insurance through the ACA. Before the ACA, no state had nearly universal (95 percent or higher) health coverage for non-elderly women of color, and only Massachusetts had nearly universal coverage for women overall. Now, three states and D.C. have nearly universal coverage for women of color and a majority has 80 percent or more. Five states and D.C. have nearly universal coverage for women overall and a majority has 90 percent or more of women overall covered. Now millions of those women are at jeopardy of losing their health care.

If these cuts scare you or ignite a passion in you to fight for change, read this guide by the Friends Committee on National Legislation on how to lobby senators about health care. This short but thorough resource gives advice on who to bring with you, how to schedule a meeting, ways to learn more about the health care so that you can show up armed with facts, and other miscellaneous tips to make your visit as impactful as possible.

There is a lot of work to be done to ensure equitable access to affordable health care for all, but there’s no limit to what we can accomplish together in solidarity.

Affordable Care Act
Budget and Appropriations
health care
Health Care Reform
People's Budget
Poverty and Income
Resources from around the Coalition