Today, the U.S. Senate released their previously “secret” version of the American Health Care Act. Senate Republicans worked on this version behind closed doors with no input from health care consumers, experts, providers or insurers.
Despite assurances from Senate leadership and President Trump to the contrary, the Senate version actually is “meaner” than the House version and will negatively affect most Coloradans.
Here are a few things the legislation will do:
* Those who received Medicaid coverage as a result of expansions from the Affordable Care Act will lose their coverage by 2020. The so-called “glide-path” included in the bill reduces the enhanced federal match rate annually between 2020 and 2024. Given Colorado’s budget issues and constitutional spending limits, there is no likely glide-path for the 450,000 Coloradans who will lose Medicaid coverage in only two and a half years. This formula expedites the glide-path originally conceived in the House version and will have more devastating effects in Colorado.
* The plan moves Medicaid funding for most populations to a per-capita cap, and ties the inflation index rate to CPI-U beginning in 2025. CPI-U is the Consumer Price Index (CPI) Urban. The CPI takes medical inflation into account but averages it across a range of consumer goods and services. As a result, it is not an accurate reflection of the medical inflation the state will have to fund. There is no way the state will be able to maintain our current Medicaid program using such a low inflation index.
* Lawfully present immigrants will lose eligibility for premium assistance — making it harder for them to obtain or afford insurance. The plan strips eligibility for premium tax credits for most lawfully present immigrants who are working hard but are not able to pay the full cost of health insurance — unless they have been a lawfully permanent resident for five years.
* The plan penalizes older Americans by making premium tax credit amounts dependent on income and age. For example, someone age 59 or older with an income between 300 and 350 percent of the federal poverty level will pay 16.2 percent of their income in health insurance premiums. Meanwhile, a 29-year-old in the same income range will pay only 4.3 percent.
* The plan shifts the responsibility to establish a Medical Loss Ratio (MLR) requirement to states. The ACA’s MLR requirement has meant that insurance companies had to spend 80 to 85 percent of your premium dollar on your health care. This change means that rather than using the power of the federal government to rein in costs, states will now have to fight this battle with insurance companies.
* The plan reduces affordability by ending the Cost Sharing Reduction program by 2020. The CSR program is critical to ensuring that lower-income individuals can afford their co-pays and deductibles.
* The plan removes the affordability exemption available in the ACA which permits an employee who cannot afford health insurance through their employer to move into a subsidized plan through a health insurance exchange.
* The plan maintains the current Medicaid financing structure for blind and disabled children and Medicaid-Medicare dual-eligible individuals. While these populations absolutely need protection, so does everyone else covered in the Medicaid program.
While the plan is even worse than what came out of the House, it has a good chance of passing since the Republicans who crafted the legislation hold a thin majority in the Senate. Colorado and America cannot afford for this plan to become law.