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This Week in Trumpcare

A quick, informative breakdown on the proposed changes to federal healthcare policy from the H*yas for Choice Board

What happened?

For the past several weeks, Senate majority leader Mitch McConnell has been drafting a health care bill completely behind closed doors. The Better Care Reconciliation Act of 2017, meant to replace the Obama administration’s Affordable Care Act (ACA), is an amended version of the bill put forth in May by the House of Representatives, the American Health Care Act (AHCA). In addition to leaving a projected 54 million Americans without insurance over the next decade, the Senate’s bill will provide billions of dollars in tax breaks to the wealthy and attempt to offset this loss in revenue by cutting health care benefits from women, low-income people, people of color, elderly people and people with disabilities and chronic illnesses. On Thursday, the text of McConnell’s secret bill was finally released, simultaneously to Congress and to the public.

What changes were included from AHCA to BCRA?

Like its House counterpart, the Better Care Reconciliation Act attempts to cut taxes on the country’s highest earners, those with annual incomes of $250,000 or more. In comparison with the previous version of the bill, however, the Senate’s proposed plan contains more drastic cuts to Medicaid over a longer period of time. At the time of the AHCA’s proposal, the Congressional Budget Office estimated that some 23 million Americans would lose their healthcare coverage under the House’s bill; current projections are even higher. And unlike the House bill, the Better Care Reconciliation Act repeals the ACA’s individual mandate while making no attempt to replace it.

What are the key differences between Obamacare and the new plan?

House and Senate Republicans alike are working to, overall, cut healthcare spending – particularly to Medicaid, which allows low income people to access a variety of healthcare services at a reduced cost or with no cost at all. The ACA brought with it a number of taxes that helps the federal government to pay for these services; the new bill will seek to repeal most if not all of these taxes, including those on millionaires and billionaires. In short terms, the bill being considered by Congress repeals:

  • Taxes on drug companies, tanning salons, health insurers, medical device manufacturers, investment income, and incomes over $250,000. While no longer requiring these taxes on the wealthy, the new bill will take away tax credits that under Obamacare helped middle-class families pay for out-of-pocket medical expenses.

  • The individual mandate, requiring and incentivizing people to be and stay insured. The AHCA replaced the mandate by charging anyone who goes 63 days without insurance a 30 cent surcharge on their premiums for a year. The bill released on Thursday, however, repeals the mandate and replaces it with nothing.

  • The employer mandate that ensures penalties for any company with more than fifty employees that fails to provide them with health insurance.

  • The mandate requiring insurers to cover essential health benefits, including mental health counseling and women’s sexual and reproductive health services. The new bill will allow states to waive these requirements.

  • Medicaid expansion. The new plan, instead of expanding the program, will cut $880 billion.

  • Protection against additional costs or the denial of care for plan-holders with pre-existing conditions. The new healthcare plan will allow states to waive this mandate, allowing employers to charge extra for plan-holders with conditions such as alcohol dependency, high blood pressure, eating disorders, acne, asthma, anxiety, “transexualism,” and pregnancy.

Who is affected by these changes?

The bill before Congress takes away care from millions of Americans from a variety of backgrounds and groups; this being said, the hardest hit by these changes will undoubtedly be people from marginalized groups, including low-income people, people of color, people living in rural areas, people with disabilities and chronic illnesses, women, and people with reproductive health needs. These are the ways in which people can lose coverage based solely on who they are:

  • People who qualified for Medicaid under Obamacare. The new healthcare plan will end the ACA’s Medicaid expansion by 2021, meaning that people who previously did not qualify for its benefits will lose them again.

  • People who qualified for Medicaid before Obamacare. Currently under the ACA, the federal government matches or nearly matches state spending on Medicaid. The new plan will instead impose a “per capita cap” on federal Medicaid spending, which would amount to hundreds of billions of dollars taken away from recipients in just ten years.

  • People with disabilities who use in-home care. Medicaid mandates institutional care for people with disabilities while community-based support is only provided based on the availability of state and federal funds. This means that cuts to Medicaid will directly cut funding for in-home services. For disability rights activists and people with disabilities, this is not an issue of preference; it is an attack on their autonomy and civil rights.

  • Low-income people who don’t qualify for Medicaid. The ACA ensured tax credits covering 70% of medical expenses; today’s bill brings that number down to 58%, raising the cost of deductibles and copays.

  • Anyone who utilizes Planned Parenthood’s services. The Republican bill would end federal reimbursements for Planned Parenthood’s services, meaning that Medicaid and Title X recipients would be forced to pay for contraception, STI testing, pap smears, and cancer screenings out of pocket. Over 60% of Planned Parenthood’s patients access its services through these publicly funded programs. More than half of Planned Parenthood’s clinics are in rural and/or medically underserved areas, and nearly half of its patients are women of color.

What does “defunding” Planned Parenthood mean?

Planned Parenthood clinics across the country receive Medicaid and Title X reimbursements, which allows medical professionals to serve, consult and treat patients with reproductive health needs and limited financial means. A vote to “defund” Planned Parenthood would end these reimbursements, meaning that patients who rely on federal programs to access their sexual and reproductive healthcare would have their care taken away. This change is directed almost entirely at low-income people, and disproportionally at Black and Latina women, who are significantly more likely to be diagnosed with and die from cervical cancer. Planned Parenthood presently receives reimbursements for the provision of birth control methods, STI testing, cancer screenings, pap smears, and breast exams, all of which Medicaid and Title X recipients would resultantly be expected to pay for out of pocket.

Although anti-choice legislators such as Speaker Ryan claim that their motivation for “defunding” Planned Parenthood is to keep taxpayer money from paying for abortions, the reality is that Medicaid has already been blocked from funding abortion services by the Hyde Amendment since 1976. Therefore, the only services affected by the ban will be those listed above; abortion care, at the federal level, was already “defunded” four decades ago.

What can I do?

As Congress continues to deliberate its healthcare bill, legislators are listening to their constituents. When you make a quick phone call to your senators’ offices, the staff member with whom you speak will make note of your opposition to the passage of the bill and relay this information to your legislator. Don’t know quite what to say? Planned Parenthood Action Fund provides a guide on how to call and produced this script.

H*yas for Choice remains committed to monitoring changes to this issue and providing you with accurate, timely updates. As always, HFC will continue to resist this dangerous, oppressive bill and keep you informed as to what’s going on and what we, as a community, can do about it.

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