Weekly AzPHA Public Health Policy Update

A couple of weeks ago he nonpartisan Congressional Budget Office (CBO) released its final analysis of the House Republican’s American Health Care Act (AHCA) which was passed by the US House of Representatives by a vote of 217-213 on May 4.  The Vote in the House came before the CBO evaluation of the Bill.

CBO’s new analysis of AHCA estimates that 14 million Americans would lose health insurance in 2018.  By 2026 they estimate that 23 million would lose health insurance under the House version of AHCA. 

The measure would convert federal Medicaid (AHCCCS) funding to a per capita allotment and limit growth beginning in 2020 (using 2016 as a base year).  States could also choose to receive Medicaid funds as a block grant instead of the per-capita allotment. These are troublesome provisions that shift financial risk to AZ from the federal government ...  setting up an environment that increases the likelihood that we would have future reductions in eligibility and covered services for Arizonans that get their health insurance through Medicaid (including vulnerable populations).

The Bill would also shift more of the cost of care to consumers through higher out-of-pocket expenses. Premiums could go down for some people, but premiums for low-income Americans and seniors would increase.  Subsidies would shift from income-based to age-based, with subsidies increasing with age.

It would also eliminate the Prevention and Public Health Fund beginning in 2019, block Planned Parenthood from receiving Medicaid reimbursements for services (for one year).

The Kaiser Family Foundation has a very helpful set of resources on their website that helps explain the differences between the current health care law and what would happen if the AHCA were enacted as passed by the US House of Representatives.

The Bill as passed by the US House of Representatives would:

  • Convert federal Medicaid (AHCCCS) funding to a per capita allotment and limit growth beginning in 2020 using 2016 as a base year and provide states the option to get a block grant instead of the per-capita allotment. 
  • Editorial comment: this provision (in my opinion) the most problematic proposal in AHCA as it would shift financial risk to AZ from the federal government and set in motion a sequence of events that would likely result in reductions in eligibility and covered services for vulnerable Arizonans. 
  • Sunset the federal funds that paid for Medicaid expansion (to 133% of federal poverty) on January 1, 2020 except for people enrolled in the expansion population on 12/31/19 and who don’t have a break in eligibility of more than 1 month.
  • Replace the current income-based tax credits with flat tax credits adjusted for age. Eligibility for new tax credits phases out at income levels between $75,000 and $115,000.
  • Impose late enrollment penalty for people who don’t stay continuously covered.
  • Repeal the Prevention and Public Health Fund at the end of Fiscal Year 2018.
  • Encourage use of Health Savings Accounts by increasing annual tax- free contribution limit and through other changes.
  • Establish a fund ($115 billion over 9 years available to all states), and additional funding of $8 billion over 5 years for states that elect community rating waivers (let insurance companies charge more for people with pre-existing conditions). States could use the money to provide financial help to high-risk individuals, promote access to preventive services, provide cost sharing subsidies, and for other purposes.

Our parent organization, the American Public Health Association,issued a statement highlighting the CBO’s findings and urging the Senate to work in a bipartisan manner that builds on the strengths of the Affordable Care Act.

We're encouraging AzPHA members to send messages to our Senators urging them to focus on supporting a Senate bill that, first and foremost, protects Medicaid and that also allows folks with pre-existing conditions to be able to continue to have access to affordable health insurance.

Senator John McCain

Washington, DC Office:        202.224.2235

Phoenix Office:                    602.952.2410

Senator Jeff Flake

Washington, DC Office:        202.224.4521

Phoenix Office:                    602.840.1891