The Fight for Health Care Justice Must Continue
By Michael Miller, Strategic Policy Director, Community Catalyst and Ashley Blackburn, Policy Analyst, Community Catalyst
The election is over and Donald Trump, to the surprise of many, will be the next president of the United States. While the election results will have a profound impact on a range of public policies, the Affordable Care Act (ACA) faces a threat like never before. The urgent question that confronts us now is how to preserve the coverage gains and financial protections that millions of people now enjoy. Twenty-two million people could lose their coverage outright if the ACA is repealed, but that is just the tip of the iceberg.
For decades, communities of color have disproportionately carried the burden of being uninsured, but that has changed in the last three years thanks to states expanding Medicaid and opening their Marketplace doors. The Latino and Black communities, in particular, saw a significant decline in their uninsured rate. Beyond access to an insurance card, the ACA has been chipping away at health disparities by protecting people with pre-existing conditions from coverage exclusions, banning lifetime benefit caps and the ability to charge women more than men for coverage, and improving access to preventive health services such as screenings for diabetes, colon cancer and high blood pressure. All of these protections are at risk if the ACA is unraveled.
And the damage doesn’t stop there. House Republicans have put forward the outline of a plan that would undermine coverage and make deep cuts to federal funding for state Medicaid programs threatening tens of millions of low-income families, seniors and people with disabilities. If realized, these cuts will fundamentally change how Medicaid operates resulting in reduced eligibility, fewer covered services, lower payments to providers and increased costs to beneficiaries — all of which would reduce access to care for the most vulnerable among us.
What to Expect Next
For six years, Republicans have been talking about repeal and replace, but they have yet to coalesce around a replacement plan. Now Republican leaders in the House and Senate are pursuing a strategy of repeal now and replace later. They are proposing to light a fuse by repealing essential components of the ACA but delaying the effective date. Essentially, they’re saying, “Trust us we’ll come up with something good to replace it before the bomb goes off.” But nothing from the past six years should give people any confidence that Republicans can pull it off. What’s more, even if there is a delay in funding cuts for benefits like premium tax credits, don’t expect insurance companies to continue participating in the marketplaces given the uncertainty that lies ahead. And the more uncertainty there is about the shape of any future health care system, the less likely healthy people are to sign up for coverage. This will drive up premiums leaving people with chronic conditions, who need care the most, with fewer options and a bigger price tag.
Once funding for premium tax credits and Medicaid expansion is repealed, it is no longer available to help finance a replacement plan. This means that whatever comes next will be much stingier than would be the case were that funding still available. Reduced funding will not only undermine coverage for the newly insured, it will also financially destabilize many providers and result in a large cost-shift to state government. The tighter state budgets are squeezed, the more quickly we can expect the progress we’ve made toward a healthier population, especially in communities of color, to regress.
Repeal without replace is not an option.
Because separating repeal from replace would be so damaging, it is important to mobilize now against this approach. Republican leaders are hoping to hold a repeal vote in January in order to present a repeal bill on or near Trump’s first day in office. The health care community is now focused on opposing this plan to repeal the ACA without a replacement.
Donald Trump was elected by a minority of the electorate. Most people in this country do not want to see the ACA repealed. They don’t want to go back to the days when insurance companies could discriminate against people based on their health status. They don’t want to cut health benefits to low-income families and people with disabilities. We’ve spent the last six years removing barriers to care that have contributed to significant health disparities across the country, and we know our work is far from done. Our challenge now is to ensure that the views of the minority do not undermine the hard-won health security for millions of Americans – especially our most vulnerable populations.