Federal Budget Watch, May 3

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New changes and developments surrounding the AHCA 2.0 bill appears to be “winning back” moderate R no votes. Today is an incredibly crucial day in stopping this bill and your help is needed.

Please call your members of Congress and urge them to vote no. The new bill is still fatally flawed. Don’t let the promise of increased funds for high risk pools fool you. Coverage is at risk for millions.

More information on why this bill is detrimental below. 

According to the latest intel from our partners at the Center on Budget and Policy Priorities, it is very possible the AHCA bill could go to the House and pass tomorrow. In fact, some moderate R members have gone as far as to publicly say they think this bill will pass in the House. Below are some key points on the updated bill:

1. GOP leadership is indicating they have the votes and both they and the White House are pushing HARD for a vote tomorrow.
2. The Upton-Long amendment – congressional leaders are reportedly considering adding an additional $8 billion in federal funding for high risk pools, to try to solve the problems the AHCA would create for people with pre-existing conditions. But this would come nowhere close to addressing the bill’s funding shortfalls, or solving the other problems it creates for people with pre-existing conditions. This promises to be a dangerous fig leaf moderates can hide behind to justify voting for this bill.
3. As of this morning, this change has won back some key House R moderates – Long, Upton, Gosar, Barletta and several New York R’s. The good news is there are still many leaners/undecideds still out there – and the facts/tools are on our side to keep the pressure on them to vote no.
4. All of the harmful provisions in this bill still exist – this does nothing to address the gutting of subsidies, the taking away of pre-existing condition protections, and the other negative elements of this bill. This is a really important point we need to focus on.

Our Goal Today & How You Can Help:

• Get moderates who are public NO votes to RE-COMMIT to voting no today. We want to be sure they haven’t been taken in on this addition of funds to the risk pools. If they re-commit as a no, consider a Thank You for standing strong against any bill that does not improve coverage, access and affordability to healthcare.
• Flood the leaners/undecideds with phone calls, emails, posts, tweets – we recognize this is the work you’ve already been pushing, but it’s working! And if you have anything left in the tank to turn it up a notch, this is the time to make that ask. The goal is to make sure these members know 1) there are MANY people in their district engaged and watching how they will vote 2) it’s not going to be worth it to vote yes on this, because they will be held accountable in their districts.

Background and key points

An earlier amendment to the House bill, offered by Representative MacArthur, would let states waive the ACA’s prohibition on charging people with pre-existing conditions higher premiums and its requirement that all health insurance plans cover basic services. Now, congressional leaders are reportedly considering adding an additional $8 billion in federal funding to the bill to try to solve the problems that approach would create for people with pre-existing conditions. It’s not clear whether the $8 billion would go toward state high risk pools, or toward some other purpose. But either way, it would come nowhere close to addressing the bill’s funding shortfalls, or solving the other problems it creates for people with pre-existing conditions.

$8 billion falls far short of what is needed to make high-risk pools minimally sustainable. The $8 billion reported increases represent a 6 percent increase in the $130 billion the bill already included for grants to states, funding states could use for high-risk pools. But experts have concluded that – even if all $130 billion were used for high-risk pools – that would still leave these pools underfunded by at least $200 billion (other experts have arrived at much higher estimates). Over 10 years, the $8 billion increase would be insufficient to fill the funding shortfall for Michigan, Missouri, Colorado, much less nationwide.

High-risk pools also have more fundamental flaws. Where the ACA made it possible for people with pre-existing conditions to get the same kinds of insurance as everyone else, the amended House bill would segregate them in high-risk pools that pool sick people with even sicker people. Historically, that led to coverage with very high premiums, benefit exclusions, annual and lifetime limits, and other problems – even when pools were sufficiently funded to avoid waiting lists.

Equally important, the House bill creates other major problems for people with pre-existing conditions that an additional $8 billion doesn’t even purport to solve. These include:

• Allowing insurers to go back to putting annual and lifetime limits on coverage for people with employer plans. Importantly, if even one state takes advantage of the MacArthur amendment to largely or entirely eliminate requirements for plans to cover essential health benefits, then large employer plans in every state could go back to imposing lifetime and annual limits on coverage. As a Brookings analysis explains, that’s because the ACA’s ban on lifetime and annual limits only applies to essential health benefits, and large employers get to decide which state’s definition of essential health benefits they want to adopt. This means that, even if Republicans altered their bill to protect people with pre-exiting conditions in the individual market, millions of people with pre-existing conditions who have coverage through their employer would be back to a world where they had to worry about exhausting their benefits each year – or for life. Before the ACA, 70 million people covered by large employers, including millions of children, had lifetime limits on benefits, meaning their health insurance coverage could end – for good – in the middle of a serious illness.
• Effectively ending Medicaid expansion. Under the House bill, the federal government would no longer provide enhanced funding for new Medicaid enrollees after 2019, forcing most or all of the 31 states and Washington D.C. that have adopted the ACA’s Medicaid expansion to drop it. Medicaid expansion currently covers 11 million people who have high rates of pre-existing conditions. For example, almost 30 percent of those benefiting from Medicaid expansion have a mental illness or substance use disorder. This means that even if Republicans altered their bill to protect people with pre-existing conditions in the individual market, millions of people with pre-existing conditions would still lose coverage and access to care as a result of the bill. 
• Dramatically raising premiums for older Americans. 84 percent of people age 55-64 have pre-existing health conditions. Under the House bill, older consumers could be charged premiums five times higher than younger consumers and would also see reduced tax credits. This means that even if Republicans altered their bill to drop the amendment allowing people to be charged more because of their health status, millions of people with pre-existing conditions would face unaffordable premiums because of their age. Moreover, high-risk pools are only intended to serve those with the most serious health conditions, but many older people have pre-existing conditions like hypertension and asthma that likely would not qualify them for high-risk pools, but could still expose them to additional premium surcharges.

Principles for Healthcare – any bipartisan measure or proposal should meet the below standards:

Access to coverage: Proposals must, relative to current law:

• Increase or maintain the number of people with health insurance
• Improve or maintain the stability of the individual insurance market

Affordability of coverage: Proposals must, relative to current law:

• Reduce or maintain the net premiums people pay
• Reduce or not increase deductibles and other cost sharing charges
• Not make coverage less affordable or adequate for people with low incomes

Quality of coverage: Proposals must, relative to current law:

• Retain benefit standards, including essential health benefits and protections against discrimination
• Not make coverage less affordable, adequate or accessible for people with pre-existing or chronic conditions or those in poorer health

We need to do everything we can to keep pressure on the House moderate Republicans – to make sure those who were earlier NOs stay that way. Ask Colorado members to commit to opposing any bill or provision that causes millions of people to lose coverage, ends the ACA Medicaid expansion, shifts hundreds of billions of Medicaid costs to states, or makes individual market coverage less affordable.

Contact info for Colorado congressional delegation:

Sen. Cory Gardner – 303-391-5777  Email here.

Sen. Michael Bennet – 303-455-7600 / 866-455-9866 Email here.

Rep. Diana DeGette (CO District 1) –  303-844-4988 Email here.

Rep. Jared Polis (CO District 2) – 303-484-9596  Email here.

Rep. Scott Tipton (CO District 3) – 970-241-2499 Email here.

Rep. Ken Buck (CO District 4) – 970-702-2136   Email here.

Rep. Doug Lamborn (CO District 5) – 719-520-0055   Email here.

Rep. Mike Coffman (CO District 6) – 720-748-7514  Email here.

Rep. Ed Perlmutter  (CO District 7) – 303-274-7944 Email here.