Proposals to replace the Affordable Care Act will harm with people with HIV and HCV

Republicans in Congress and the administration are proceeding with legislation to repeal the Affordable Care Act, which has led to significant gains against HIV and hepatitis C. Their proposals will end health care coverage for millions of people, among them people you care about. We wanted to inform you of the legislation that moved through two Committees of the House of Representatives last week, and why we oppose it. We also want to educate you about core principles behind the repeal and replacement, and why they are so problematic. From time to time, we will update you as this urgent issue progresses, and ask for your help in asking your representatives in Congress to do everything possible to assure affordable, quality health care coverage for all.

The “American Health Care Act” Will Hurt People Living with and at risk for Hepatitis C, HIV, and other Chronic Conditions

If passed, the AHCA will

  • End the Medicaid expansion that extended health coverage to millions more. See which states would be affected. This will reduce by millions the number of people who can be covered by state Medicaid programs. Approximately 40% of Americans living with HIV are covered by Medicaid and people living with HIV have benefited from the Medicaid expansion. People living with hepatitis C are also more likely to rely on Medicaid for health coverage.
  • End Medicaid as we know it, potentially saddling states with new health care costs by placing a cap on what the federal government pays them for each person covered by their Medicaid program. This cap will hinder states’ ability to cover unexpected health care costs, like covering newly released innovative medications that are expensive (e.g., the direct acting antivirals that cure hepatitis C), or responding to novel disease breakouts.  More about why per-capita caps are a bad idea.
  • Substantially reduce the premium subsidies that help millions afford insurance through health exchanges. The proposals end financial assistance for 6.3 million lower-income people that helps them reduce their out-of-pocket costs, such as deductibles. Many of these people could see their deductibles increase by as much as $5,500. People with chronic illnesses will be hurt the most, left with only bare-bones coverage that comes with drastically higher deductibles. These individuals will once again be forced to go without lifesaving treatment or go into debt to get the care they need.
  • Require people to maintain “continuous coverage” or pay more in premiums. While the Republican proposal does preserve the all-important provision from the Affordable Care Act for coverage of pre-existing conditions, it requires that people maintain continuous insurance coverage or be subject to 30 percent increases in their premiums.  This provision intentionally leaves people unable to purchase insurance.  Maintaining continuous coverage can present a severe challenge for people who enter and leave the employment market, or have other challenges to remaining insured.
  • Make health coverage more expensive for older Americans. The legislation proposes higher premiums for coverage of older individuals because their health care costs tend to be higher. The reduction in premium subsidies will hurt people living with HIV and hepatitis C. A quarter of people living with HIV are over the age of 55. Baby Boomers (people born between 1945-1965) are five times more likely to have hepatitis C than other adults. It is critical that these communities have access to affordable health coverage to treat these chronic conditions, as well as to address their broader health care needs.
  • Change health savings accounts (HSAs) in ways that would only help the wealthy. The financial assistance in this bill is so inadequate that most lower- and moderate-income people will struggle to afford premiums for the plan they have today.  HSAs don’t work for most households, especially those living paycheck to paycheck and who can’t afford to set aside thousands of dollars to pay the full cost of their health care bills. This bill would just open the door for wealthy people to stash more money in these accounts to avoid paying taxes. The majority of individuals who actually put money into HSA’s live in households making more than $100,000 each year.
  • Repeal provisions in the ACA that improve access to behavioral health services, like substance use treatment and mental health services. These services are critical to preventing and responding to outbreaks of HIV, hepatitis C, overdose, and other conditions.
  • End funding for Planned Parenthood. Many people at risk for HIV and hepatitis C receive preventive services, like PrEP (HIV pre-exposure prophylaxis), condoms, STD testing and treatment, HIV and hepatitis C testing and linkage to care services at Planned Parenthood.
  • Eliminate the Prevention & Public Health Fund. This fund provides expanded and sustained national investments in prevention and public health to improve health outcomes and enhance health care quality. Of note, the Prevention & Public Health Fund supports state, local, and territorial health departments’ capacities for detecting and responding to infectious diseases, such as hepatitis C and HIV, and other public health threats.

We don’t know the bill’s full impact on the federal budget. In a highly irregular move, House Republicans are rushing this bill through committees without releasing a formal cost estimate from the nonpartisan Congressional Budget Office (CBO), which analyzes how much federal legislation will cost or save American taxpayers—known as a “score.”

What you can do: Contact your representatives

Call 866-426-2631

Use this toll-free line provided by our friends at SEIU. Here are sample messages:

  • Lawmakers should not vote on the bill until they know the impact it will have on the federal budget and, more importantly, the more than 20 million people who have gained coverage under the Affordable Care Act.
  • Demand that lawmakers follow the normal procedures, hold formal hearings, and wait to vote until the Congressional Budget Office (CBO) reviews the bill and gives it a score.

Much of this summary is adapted from materials by our friends at Families USA, including this fact sheet, “Healthy and Wealthy Benefit under the House Republicans’ Affordable Care Act Repeal Plan” 

For a short summary of some of the provisions in the “American Health Care Act” that differ from the ACA, see “The Parts of Obamacare the Republicans Will Keep, Change or Discard” in the NY Times.

Want more detail? May we suggest this article, Examining The House Republican ACA Repeal And Replace Legislation, by Timothy Jost.