As people with diabetes, we recognize that the ACA was not perfect, but the proposed legislation will be harmful to those in our ever-growing diabetes community.
DPAC gives you the rundown of what’s in the bill as it is currently written and what can happen to those in the diabetes community if it does pass.
What is in the Delayed Republican Health Care Bill?
The news has been filled with chatter over the American Health Care Act, also called Ryancare, or Trumpcare, depending on who you ask. To understand what this bill is about requires understanding two fundamental things.
First, virtually all Republicans in Congress have promised for many years that they would “repeal and replace” the Affordable Care Act if they ever had control of Washington. Now Republicans run the show, but they are limited by a second factor.
Republicans do not have the 60 votes needed to pass legislation in the Senate. That means that they can really only pass legislation through the Senate using a “reconciliation” process that requires just 50 votes. This process is only allowed for budget-cutting measures.
As a result, the American Health Care Act bill being pushed by House Speaker Paul Ryan would only do a handful of the things that Republicans eventually hope to do. There has been some discussion of last-minute changes to the bill that would involve more aggressive action on regulations for what health benefits each insurer must offer.
As initially presented, however, the bill had four main provisions.
Eliminate of the Prevention and Public Health Fund
Republicans have long been critical of a nearly $2 billion program started in 2010 to help shift focus from treatment to prevention. They say it’s an unaccountable “slush fund,” but the program has allocated $72 million in 2017 for research to improve and enhance diabetes prevention and control strategies through the National Diabetes Prevention Program.
What that means to the diabetes community: That allocated money would be eliminated with some shifted to programs like Community Health Centers that Republicans favor.
Repeal the Medicare Expansion and Cap Payments
Medicaid currently covers around 75 million adults and children around the country, and about 11 million of those joined after the program was expanded in 2010. Most of these people are living with reduced or small incomes, often under the national poverty level.
Republicans worry that “entitlement” programs like Medicaid, along with Social Security and Medicare, are leading the country to financial ruin. The prevent that outcome, the Republican health care bill would roll back the 2010 expansion and convert Medicaid to a matching program.
The federal government currently pays 50% to 75% of Medicaid’s costs, with states picking up the rest. The costs for the federal government can fluctuate based on the cost of health care, how much states are paying, and the number of people in the program. The Republican bill would eliminate that fluctuation and instead just send states a capped subsidy for every person that state has in the program.
The Congressional Budget Office has said these changes could cause 14 million fewer people to have coverage by 2026.
What that means to the diabetes community: That means that many low-income diabetes patients could lose health coverage completely. It could also cause real damage to state budgets.
Health Insurance Market Reforms
One of the most frequent complaints about the 2010 Affordable Care Act is the law’s complicated subsidy scheme tied to income that left many marketplace participants confused about their true out-of-pocket costs. The Republican bill would eliminate those subsidies and replace them with a more simple age-based system.
The Republican bill would offer a tax credit that ranges from $2,000 for anyone under 30 to $4,000 for anyone over 60. The New York Times and many others have put together examples of how the change would work out in practice. One of their examples is a 64-year-old married accountant with diabetes making $65,000. That person might actually be better off under the new law. On the other hand, a 28-year old barista would probably be worse off. The changed subsidy scheme will impact people differently, but most analysis points to more out-of-pocket costs for most people.
This section of the bill would also make a few other changes to the markets.
- It adds an “incentive” for keeping individuals on continuous coverage.
- It would also allow insurance companies to charge older people more.
- The 2010 law says that the oldest patient cannot be charged more than three times the premium of the youngest patient, and that would be rolled back.
- The bill would also create a “Patient and State Stability Fund” that would set aside $100 billion for states to promote innovative solutions to lower costs and increase access. This is essentially a “high risk pool” that has failed in previous attempts.
What that means to the diabetes community: This could result in increased costs for older diabetes patients, those who may lose coverage due to loss of employment and can’t afford COBRA or new plans, and force people with diabetes into highly restrictive risk pool plans that may not cover current diabetes management medications, devices, or services.
The 2010 Affordable Care Act was paid for in large part by a number of tax increases, and the Republicans want to cut them all back. The Republican bill would eliminate the individual and employer mandates and their associated taxes. Taxes on health savings accounts, tanning beds, and medical devices would be gone. Income-based caps on various tax benefits would be removed.
What that means to the diabetes community: Everyone that gets a tax cut would certainly benefit, but that does reduce the funding available to pay for quality, affordable health care.
No Winners, Only Losers
The United States won’t “win” even if the proposed bill passes. There will be plenty of losers: people with diabetes are at the top of the list. Delaying this vote and working to fix ACA or a better plan to repeal and replace is warrented.
We at DPAC work to elevate the voice of people with diabetes in the policy advocacy areas of safety, quality, and access.
The current American Health Care Act will not provide access to health care for millions of people with diabetes.
This is why until we are sure that any health care measure presented by Congress protects all people with diabetes, we are asking them to delay repealing ACA and listen to their constituents. We hope you will ask them to raise our collective voice.