By Clayton Huckaby
Kern Valley Sun
On Thursday, May 4, Republicans in the House of Representatives narrowly pushed through their health care bill.
The bill, known as the American Health Care Act (AHCA), was created by House Republicans to replace the Affordable Care Act (ACA). The ACA, colloquially referred to as Obamacare, sought to lower the overall cost of health care by bringing more people into the system. Despite its intentions, the ACA has caused some problems of its own. As a result, Republicans tailored much of their platform around abolishing the ACA and replacing it with a conservative alternative. Thus, the AHCA was born.
There are a number of things that the AHCA will do if it passes the Senate in its current form. Namely, it will allow states to apply for waivers to opt-out of provisions that prohibit insurance companies from discriminating against people with pre-existing conditions. It will also allow states to apply for waivers to opt-out of the ACA’s essential health benefit provisions requirements.
The “essential health benefits,” as prescribed by the ACA, are ambulatory patient services, emergency services, hospitalization, maternity and newborn care, mental health and substance abuse services, prescription drugs, rehabilitative services, laboratory services, preventive services, and pediatric services. It is important to note that states, by default, will not be able to opt-out of these services, but they have the option to apply for a waiver if they can show that it will help extend coverage in their state.
It is clear, from both Democrats and Republicans, that health care reform is necessary, but the AHCA has provisions in it that many may find hard to stomach. For one, the AHCA rolls back the Medicaid expansion that was fully implemented by the ACA in 2014. The ACA increased overall Medicaid coverage by creating a minimum Medicaid income eligibility level.
It also made available federal funding for the Medicaid expansion. Essentially, states were given money to ensure that low-income individuals could be covered under the new provisions.
Currently, the federal government funds 100 percent of the cost for those covered under the expansion. By 2020, that was supposed to decrease to only 90 percent.
Medicaid, or as it is called in California, Medi-Cal, is one of the biggest insurers in California. More than one quarter of all Californian’s are on Medi-Cal, but that number is much higher in Kern County. Under the ACA, nearly 3.2 million people signed up for Medi-Cal coverage. That is more than the approximately two million that gained insurance through the ACA marketplace, Covered California.
According to the California budget center website, as of January 2016, there were 399,679 Medi-Cal recipients in Kern County alone. That is 45.1 percent of the population of the county. While not all of those on Medi-Cal will be taken off of the program, it is likely that several million people throughout California will lose coverage. It is estimated that nearly 13 percent of the population will lose Medi-Cal coverage if the AHCA passes. In Kern, that means approximately 52,000 people could be left without health care.
Despite the bill passing the House of Representatives, it still has a long way to go before it will be made law. The Senate is set to be a battleground for the bill. Many Senate Republicans have been reserved about supporting the bill. Senator Rand Paul has expressed concerns about whether the bill goes far enough in repealing the ACA. The Senate majority whip, John Cornyn, has also expressed doubts over whether the Senate will pass the AHCA.
Cornyn said, “I would anticipate that we’ll do what we used to do all the time which is, the House will pass a bill, we’ll pass a bill and then we’ll reconcile those in conference committee.”
Senate Republican reluctance to accept the bill is not the only hurdle it will face in the Senate. It is likely that Democrats will also put up road blocks, and they may filibuster. The filibuster may be avoided, however, if the bill is pushed through as a budget reconciliation bill.
For the bill to be considered a budget reconciliation bill, it will have to be approved by Senate Parliamentarian Elizabeth MacDonough, an unelected, bipartisan official. If it is marked as such, only 51 votes will be needed for the bill to pass the Senate and go before the president.
As of right now, it is important to remember that the ACA is still the law of the land. It has not been repealed, and it is likely that the Senate will take its time to repeal the law.