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En español | The U.S. House of Representatives voted by a narrow margin today to repeal and replace the Affordable Care Act (ACA) with a bill that would permit discrimination against people with preexisting health conditions, substantially increase insurance premiums for older adults, result in millions of people losing coverage, and worsen the fiscal health of Medicare.
The bill, approved in a mostly party-line vote of 217 to 213, would also cut Medicaid funding, which millions of low-income seniors as well as children and adults with disabilities rely on, by more than $800 billion over 10 years.
The American Health Care Act (AHCA) drew the support of 217 Republicans. Twenty Republicans and all 193 Democrats voted against it. The legislation will now go to the Senate, where it is expected to face strong opposition and its outlook is uncertain.
The AHCA has been condemned by leading consumer and health groups, including AARP and physician and hospital organizations.
“AARP is deeply disappointed in today’s vote by the House to pass this deeply flawed health bill,” said AARP Executive Vice President Nancy LeaMond. “The bill will put an age tax on us, harming millions of American families with health insurance, forcing many to lose coverage or pay thousands of dollars more for health care. In addition, the bill now puts at risk the 25 million older adults with preexisting conditions, such as cancer and diabetes, who would likely find health care unaffordable or unavailable to them.”
Pulled from House consideration in March when it lacked sufficient votes for passage, the legislation found new life through an amendment permitting states to request waivers that would allow insurers to charge higher premiums to people with preexisting conditions. That would be a dramatic departure from the protections of current law. Twenty-five million people ages 50-64 have a preexisting condition and would face much higher premiums — thousands of dollars a year — that in many cases would be unaffordable.
While supporters of the bill maintained that people with preexisting conditions could be cared for through high-risk pools, an analysis by AARP’s Public Policy Institute found that premiums in such pools could reach unaffordable levels — as much as $25,700 a year in 2019. In the past, high-risk pools have put such an onerous financial burden on states that insurance benefits were scaled back and enrollment in them was capped.
To win over holdouts on the bill, the House leadership included an amendment adding $8 billion over five years for high-risk pools, an amount representing a very small fraction of what would be required.
Under the bill, states could also obtain waivers allowing insurers to sidestep coverage for critical benefits such as emergency services, hospitalization, prescription drug coverage, mental health services, chronic disease management and preventive care.
The controversy over how to treat people with preexisting conditions was only one objection raised by consumer groups about the AHCA. The bill would impose an “age tax” through the combined effect of allowing insurers to charge older adults five times what other consumers pay for the same insurance and reducing tax credits that help older adults pay for their insurance coverage. The result of these two big changes would be an increase in annual premiums of up to $13,000, according to the Congressional Budget Office (CBO).
Compounding this problem, insurers in states receiving a federal waiver would be allowed to charge older adults even more than five times what others pay for coverage. Current law limits the premiums for older consumers to three times what younger adults are charged.
The CBO found in March that the legislation would lead to a loss of coverage for 24 million Americans over the next decade. The House leadership plunged ahead with Thursday’s vote even though the CBO has yet to analyze the recent changes. The result was that members of Congress voted on legislation without knowing how many people would be affected and how much their premiums would be.
The AHCA wouldn’t affect only people 50 to 64 years old. The bill would also worsen the fiscal outlook for Medicare by reducing the program’s revenue. It would hasten Medicare’s insolvency by several years and weaken its ability to pay for future services for those who rely on the program to help cover their health care costs.
AARP vowed to hold every member of Congress who voted for the bill accountable by letting its nearly 38 million members know how their elected representatives voted.