What Happened?

On March 6, the Ways and Means Committee and the Energy and Commerce Committee approved the American Health Care Act as a replacement for the Affordable Care Act, commonly known as Obamacare.

If passed, the AHCA will repeal Obamacare by dismantling taxes, which include penalties for not having coverage, and providing tax credits between $2,000 and $14,000 a year for low-income families, among other initiatives, according to readthebill.gop.

The next step will be for the House Committee to approve the budget, which according to the Speaker of the House’s website, would only take a majority vote with Republicans holding 52 of the 100 seats. If passed, the bill would go the president for final approval.

The Ways and Means Committee is a tax-writing committee in the House of Representatives and the oldest committee in the U.S. Congress, according to their website. The Energy and Commerce Committee is the oldest legislative committee in the House of Representatives and oversees independent agencies and cabinet-level departments like the Department of Energy, the Environmental Protection Agency, the Food and Drug Administration and the Federal Trade Commission, according to the committee’s website.

A website created by the GOP for the act states that Obamacare was based on a one-size-fits-all approach that resulted in high payments, fewer options and less access. The AHCA proposes to cut the premium costs of Obamacare and increase health care options.

The legislation would also decrease federal deficits by $337 billion from $559 billion in 2017 to $222 billion in 2026, according to a cost estimate report for the act that was released by the Congressional Budget Office on Monday. The CBO expects premium costs to increase by 15 percent to 20 percent until 2020, and decrease approximately 10 percent below those of current law by 2026.

Qualifications for assistance will be based on age rather than income, according to the budget report, and insurers will also be able to charge five times more for enrollees 65 and over than younger ones.

However the CBO estimates that 24 million people under age 65 would also be uninsured by 2020 due to higher premiums, the retraction of penalties tied to the individual mandate and cutbacks in Medicaid and non-group coverage.

By 2026, there will be 14 million fewer Medicaid enrollees in the nonmarket group, which refers to individual policies purchased through a marketplace or directly from insurers, according to the CBO.

“The current proposal neither makes healthcare a personal responsibility, as Republicans want, nor moves the country toward collective responsibility as Democrats want,” said Cal State East Bay political science Professor Emeritus David Baggins. “This makes all sides unhappy. It is not likely to pass as written. It probably will be revised.”

The bill also proposes to transition Medicaid to a per capita allotment, a designation that  would transition control over the program to the state level. This means that states would receive a fixed amount of money from the federal government based on the amount of enrollees in the program, according to the Kaiser Family Foundation.

Currently, under Obamacare the federal government and states share the cost of Medicaid; poorer states pay less, according to a Jan. 24 Kaiser Healthy News report. Transitioning to the per capita allotment or “block grant” approach would give the states more power to decide who qualifies for Medicaid services. According to USNews.com, Medicaid currently covers 70 million low-income adults and children, or one out of every five people in the country.

AHCA would also expand Health Savings Accounts or HSA’s, tax-exempt trust accounts that reimburse qualifying enrollees for medical expenses, according to the IRS.

“Their current proposal is a diminution of ACA, but not a new thought,” said Baggins. “It does nothing to move tax supported care from high cost, low benefit coverage. It is cheaper and less beneficial than ACA; better for [people with a] higher income.”

Throughout his campaign, one of President Donald Trump’s major promises to voters was to repeal Obamacare, “the most significant health care law in a half-century,” according to a Jan. 13 article by The New York Times.

The Trump administration took the first steps to gut the program on Jan. 20, when he issued an executive order to decrease penalties for non-coverage, pending congressional repeal of the program, according to CNN Politics.

In June 2016, Paul Ryan, speaker of the United States House of Representatives, released, “A Better Way: Our Vision for a Confident America,” a Republican healthcare reform agenda. The proposal was built on five principles: repeal Obamacare, expand feasible healthcare options, protect patients with preexisting conditions, spur innovation and competition and preserve Medicare, according to the proposal. Until last week, when House Republicans passed legislation for the AHCA, it was unclear how they planned to implement those policies.

“Republicans campaigned heavily in denunciation of Obamacare, but in this moment of power have nothing to replace it with,” said Baggins. “They don’t have the integrity to admit they oppose healthcare that is partially socialist: too much of their base is made of low income cultural voters, who would suffer from flat out repeal. So they have proposed a diluted form of the old Affordable Care Act.”