President Trump and Congressional Republicans recently gathered in the White House Rose Garden to celebrate the U.S. House of Representatives’ passage of legislation that will cause 14-million people to lose their health-care coverage next year. This would be the largest one-year decline in health-care coverage in our nation’s recorded history, which begs the question of what exactly there is to celebrate.
In fact, the American Health Care Act, the cause of the Republican festivities, is a testament to broken promises. Despite the president’s commitments as a candidate, the Republican House bill he supports would return us to the days when insurers could discriminate against people with pre-existing conditions. It would worsen the opioid epidemic by gutting major programs and policies that pay for and support substance-abuse treatment. It would jeopardize both services for children with disabilities and nursing-home care for older Americans by decimating the Medicaid program. It would make it more difficult to get vital HIV treatment.
Under the House-passed bill, as soon as next year, health-insurance premiums would rise an average of about 20 percent in the individual insurance market. This increase is two-and-a-half times as much as premiums are expected to increase under current law in Pennsylvania, where the average proposed increase for 2018 is 8.8 percent. The guarantee of nationwide protections, such as the provision ensuring that these plans cover prescription drugs, would end. Also in danger is the nationwide requirement that plans cap out-of-pocket costs (such as co-pays and deductibles) for essential health benefits. Instead, under the AHCA, states could waive benefit requirements while allowing insurers to discriminate against those with pre-existing conditions.
With key protections waived, many consumers can expect to see severe spikes in their out-of-pocket costs for health-care services, in addition to the already-huge increases they could see in their insurance premiums. Non-partisan experts estimate these out-of-pocket increases could be thousands of dollars a year for some people.
Particularly vulnerable under the House scheme are older Americans who have not yet reached Medicare-eligibility age. The Republican bill would require hard-working Pennsylvanians ages 50 and older to pay an age tax. AARP estimates that those over 60 could see their premiums rise, on average, by an additional $3,200 due to this new tax alone.
At the same time, the tax credits available under current law to help make coverage affordable would get slashed for many people. The result is, you will have to pay more with less help. In one stunning example, the independent and non-partisan Congressional Budget Office estimates that under the Republican plan, a 64-year-old earning $26,500 would see her net insurance premium jump from $1,700 per year under current law to somewhere between $13,000 and $16,000 per year. Pennsylvanians simply can’t absorb those costs and will be forced to make untenable choices and trade-offs among essentials like prescription drugs, food and mortgage payments.
Unfortunately, the impact on the LGBT community is particularly severe because the community benefited so much from the Affordable Care Act. A recent study by the Center for American Progress found that LGBT Americans are twice as likely to be uninsured as non-LGBT Americans. Rates among transgender individuals are three times as high. The ACA had a tremendous impact on making sure that affordable care was available to every individual. Families with LGBT parents had a particularly difficult time finding coverage prior to the ACA, because many employers did not offer coverage for same-sex partners or their children. All of these gains could be at risk by the Republican scheme.
Unfortunately, Republicans in Congress are jeopardizing access to affordable care and so much more. Their legislation also takes an ax to the Medicaid program — slashing funding for it by $834 billion over 10 years and capping the federal role in the program. Medicaid is a 50-year-old federal-state partnership and the Medicaid expansion was instrumental in not only covering low-income LGBT Americans, but it was particularly impactful for those with HIV. HIV-positive individuals who are just above the income threshold no longer have to wait until they are disabled to qualify for life-saving early treatment. Early treatment means avoiding disability and, most importantly, preventing future transmission. According to the Kaiser Family Foundation, Medicaid is the single largest source of health coverage for people with HIV, covering more than 40 percent of those with the disease. If the federal government limits its role in the program, the Commonwealth of Pennsylvania will be left holding the bag. Already under strain, the commonwealth will have no choice but to cut benefits and services for millions of Pennsylvanians, putting an insurmountable burden on local governments to try to fill the enormous gaps and leaving the health of countless LGBT Americans at risk.
There is one population that benefits from the American Health Care Act: the wealthiest individuals in the country, who will get enormous tax cuts. In fact, at its core, the legislation is a tax bill, paying for tax cuts for the fabulously wealthy by cutting programs that help working families. Fourteen-million people will lose their health-care coverage next year, climbing to 23 million by 2026, to allow 400 people to receive a tax cut of, on average, $7 million.
Senate Republicans are currently drafting their own bill behind closed doors. In the next couple of weeks, they may bring a bill to the floor without any hearings or committee meetings to examine or amend the bill. Instead, they will likely use a fast-track procedure to rush the bill and deny the public the opportunity to understand what it will mean for them and their loved ones.
I expect Senate Republicans to adjust the House bill so that they can say they “improved the bill.” Don’t be fooled. A Senate bill that doubles your premiums instead of tripling them, as the House Republican bill does, is still devastating. A bill that increases the premium of a 64-year-old woman by $10,000 instead of $26,500 is still a recipe for disaster. And a bill that cuts Medicaid by $600 billion instead of $800 billion is still a broken promise and a gut punch to working Americans and to the LGBT community.
There is nothing to celebrate but plenty to fear from the Trump administration and Congressional Republican health-care scheme. I will continue to fight like hell against it and any proposal that causes costs to skyrocket, coverage to shrink and the health-care market to shake. The people of Pennsylvania deserve much better.
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