Yesterday, the U.S. House of Representatives narrowly voted to approve the GOP plan to reform the Affordable Care Act (ACA). While the first attempt to pass the reform package, the American Health Care Act (AHCA), was unsuccessful last month, the Administration and House leadership were able to amass a 217-213 victory. All 193 Democrats opposed the bill, along with 20 Republicans concerned with protecting those with pre-existing conditions.
What Helped the House Bill Pass?
Negotiations with Rep. Mark Meadows (R-NC), chairman of the conservative House Freedom Caucus, and Rep. Tom MacArthur (R-NJ), a co-chairman of the moderate Tuesday Group, produced an amended plan that would allow states to apply for waivers to opt out of core ACA requirements. Under this provision, states could choose whether or not insurers can charge higher premiums for those with pre-existing conditions as long as the state also offers a high-risk pool. The House plan also repeals the ACA’s essential health benefits, which define mandatory minimum plan benefits, including those for mental health and addiction services.
Later negotiations with Reps. Fred Upton (R-Mich.) and Billy Long (R-Mo.) included an additional amendment that would provide $8 billion over five years to help those with pre-existing conditions afford premiums in states that are granted a waiver through the MacArthur amendment. Many public health experts criticize this number as being far from enough to cover the true cost of those who would need this support. Combined, these amendments helped position the bill in a way that earned enough votes from members of the conservative Freedom Caucus and moderates.
What Does the Bill Mean to Cities?
The House bill was passed without a score from the Congressional Budget Office (CBO) and without congressional hearings or additional amendments, forcing many members of the House to scramble to review bill language with only three hours of debate before the vote.
Prior versions of this bill estimated that its provisions would leave an additional 24 million more people uninsured by 2026. The latest amendments did not alter any of the proposed deep cuts to Medicaid that existed in previous versions, which include taking away the Medicaid expansion provided in the ACA by 2020 that currently provides coverage to 10 million low-income Americans. It also converts Medicaid into a block-grant program that will lose $800 billion over the next decade. The impact to states, and ultimately cities, would be severe as many residents lose coverage and the financial burden of uncompensated care falls onto public and private health care providers.
This is especially concerning to cities under the backdrop of the Administration’s proposed Fiscal Year 2018 budget, which plans to strip $54 million in domestic spending from critical programs that cities rely on, from Community Development Block Grants to 21st Century Community Learning Centers and AmeriCorps.
City leaders work hard to balance the needs of their cities, from fixing roads and bridges to ensuring their residents have access to clean water and safe communities. These duties would all be made exponentially more challenging under the House-passed healthcare plan and the Administration’s proposed budget.
As NLC President Matt Zone said in a recent statement, “Congress cannot promise to fix the American health care system and stick the bill on local governments. By threatening Medicaid funding, withdrawing services for drug addiction and mental health during the nation’s deadliest drug epidemic, and reducing funding for preventative medicine and wellness programs, today’s health care bill threatens to leave millions of Americans uninsured. When the federal government pulls back on its commitment to health care, local governments, states and health care providers are left to pay the bills of increasing rates of unreimbursed care.”
The bill will now travel to the Senate where many within the Republican party have been critical of the House version, particularly as it relates to Medicaid and the impact within their states. Leader McConnell will begin work with his colleagues to craft a Senate version of the bill. In contrast to the House, the Senate budget rules require a CBO score prior to any vote that shows that the legislative impact will not increase the deficit after 10 years. The Senate has also stated their intent to hold hearings on their version of the bill.
We urge the Senate to stand with cities and to craft a piece of legislation that protects and promotes healthy communities without passing the financial burden onto local governments.
Stephanie Martinez-Ruckman is the Program Director for Human Development at the National League of Cities. Follow Stephanie on Twitter @martinezruckman.