We got our first look this week at the GOP's top secret plan to repeal the Affordable Care Act (ACA) and now we know why they worked so hard to hide it! Under the repeal bill, millions of Americans will lose their health coverage and women will be blocked from using Medicaid coverage at Planned Parenthood, so that Republicans in Congress can cut taxes on wealthy investors, corporations and the CEOs of insurance companies.
Meanwhile, public health experts from across the political spectrum have panned the bill. Even the conservative-leaning physicians group, the American Medical Association, has written in opposition, due to the “expected decline in health insurance coverage and the potential harm it would cause to vulnerable patient populations.” The AMA has been joined by the AARP, the American Hospital Association, the American Academy of Pediatrics, the American Psychiatric Association, the Federation of American Hospitals and dozens more.
While conservative opposition to the bill (for not being draconian enough!) has gotten most of the press coverage, we expect conservatives to cave to pressure from the White House—particularly if the bill moves further to the right. Instead, our focus lies with those moderate Republicans worried that their constituents will lose coverage because of this bill.
Here at RWV, we’ve updated our “What We Would Lose” fact sheet to explain how women and their families would be impacted. Here are some key things you should know about the bill.
The bill slashes financial aid to help us afford insurance
For example, a 60-year-old woman making minimum wage receives (on average) almost $10,000 in subsidies (premium tax credits) from the ACA to help her buy good insurance—and more if she lives where premiums are high. Under the GOP repeal, she would get just $4,000—no matter where she lives or how expensive her insurance.
At the same time, insurance companies could charge her 67% more for the same plan she has now. That’s because the GOP bill also allows insurance companies to charge older people five times as much as they charge younger people, compared to three times as much under the ACA. That’s an effective increase of 67 percent. Women in their 50s and 60s who lose coverage through divorce or widowhood would be hard pressed to find affordable coverage.
Bill punishes uninsured people trying to regain coverage
By contrast, young healthy people will have not much incentive to buy health insurance, because there will no longer be a tax penalty for being uninsured, and the financial aid to help them buy insurance will be skimpier. As one pundit noted, “It’s like once you’ve decided to park illegally and know you’re going to get a ticket, you might as well stay awhile.” With healthy people staying uninsured, there will be a sicker pool of health insurance enrollees, leading to higher premiums for everyone.
Ends the Medicaid expansion and guts original Medicaid
Blocks women from using Medicaid at Planned Parenthood
Under the current and long-standing law, women and their families are free to use their public health insurance at any qualified health provider who accepts it. What do we mean by public health insurance? Examples are Medicaid and the Children's Health Insurance Program (CHIP) for low-income families, Medicare for seniors and TRICARE for military families. Millions of women have used this coverage to obtain contraceptive services and counseling, STI testing and treatment, and breast and cervical cancer screenings at Planned Parenthood. Under current law, no federal funds may be used for abortion services, with rare exception.
Under the Republican repeal bill, however, women would no longer be able to use this insurance at the highly qualified provider of their choice if that provider is Planned Parenthood, which would be barred from receiving federal funds. Planned Parenthood is often the only provider in rural and other underserved areas, as Vice President Mike Pence knows. He presided over a needle-borne HIV outbreak in Indiana when a similar state measure forced five Planned Parenthood clinics to close and no other provider could fill the gap.
Families to Give Tax Breaks to Wealthy
Instead of providing financial help for comprehensive coverage, the Republican plan depends on low- and middle-income families paying more out-of-pocket costs (like deductibles and co-pays) with money they set aside in Health Savings Accounts (HSAs). Money invested in an HSA remains tax-free so long as it’s spent on a qualified medical expense, but many families do not owe income taxes and would receive no benefit. Many others have no extra funds to save. In practice, HSAs often serve as a tax shelter for the very wealthy.
It’s not surprising, then, that the other critical piece of the Republican repeal bill is an average tax cut of $7 million for the 400 richest families in America. The bill strips low- and moderate-income families of their health insurance in order to give away $275 billion in tax cuts to the wealthiest 2% of Americans. But the wealthiest households aren’t the only big winners. The bill also cuts taxes on insurance and pharmaceutical companies and re-opens loopholes in the tax code closed by the ACA to prevent tax fraud.