CB…oh no?!

Earlier this month, the House Republicans in Congress passed the American Health Care Act (AHCA) without an updated Congressional Budget Office (CBO) score. The CBO is an independent, nonpartisan office that analyzes the cost and impact of proposed federal legislation. Wednesday, in full nerd behavior I anxiously awaited the release of the new report.
While earlier versions of the AHCA revealed that over 24 million people would lose their health coverage, the effect of amendments that allowed for waivers for essential health benefits and pre-existing conditions was not yet known … until now. (Yes, 20 days after the bill was voted on by the House). What we know from the newest CBO score is that not much has changed. According to the report released yesterday:

• 23 million more people would be uninsured by 2026;
• $8 billion dollars allocated for high-risk pools would not be sufficient to cover the large increases in premiums for high-cost enrollees;
• Medicaid enrollment (including children, people with disabilities and the elderly) would decrease by 14 million people;
• People needing maternity, substance abuse & mental health care would incur thousands of dollars in extra out-of-pocket costs in states who apply for a waiver.
• Premiums would go up 20 percent more than current law in 2018.
• In states that pursue waivers, the report says that average premiums would fall but “less healthy people would face extremely high premiums.”

Last week, our national partners at the Center on Budget and Policy Priorities released two reports on the effects the AHCA has on rural America and home- and community-based services. Both of these reports once again put on display the great harm this legislation would bring.
One of the things that really stood out to me was the huge effect the AHCA would have on our rural Michiganians. In Michigan, 113,800 people in rural communities gained coverage through Michigan’s Healthy Michigan Plan. That’s nearly 20 percent of the total enrollment of the program. Those suffering from opioid addiction (of which rural Michigan has been greatly affected) have been particularly helped by the expansion of Medicaid. The coverage gained allowed these people to access the necessary treatment and education they need to fight this growing epidemic.
Home- and community-based services are optional services that states are not required to provide but many individuals rely on as a way to receive care at home rather than in a nursing home. In 2013, 102,810 Michigan residents relied on these services. Restructuring Medicaid through per capita caps and the ultimate end of Medicaid expansion would result in a significant cost shift to states, so much that states could choose to no longer provide these important services to seniors and people and kids with disabilities.
There is no doubt that the Affordable Care Act needs to be improved and as the U.S. Senate moves forward in its process, we can hope that they look at this data to develop legislation that rejects caps on the Medicaid program, continues successful Medicaid expansion programs—including Michigan’s Healthy Michigan program, and increases the number of insured individuals.
We know you are being pulled in a lot of directions right now, but we still have a lot of work to do on the healthcare front and we need you to keep fighting. We have a helpful website set up with our coalition partners so you can contact your member of Congress, and all these reports to help keep you informed on the devastating impact of the AHCA. And they come in handy when you battle your friends on the intricacies of Medicaid financing … oh wait, I’m the only one that does that?

— Emily Schwarzkopf