Statement: NASW strongly opposes legislation to repeal Affordable Care Act

The National Association of Social Workers (NASW) strongly opposes legislation to repeal the Affordable Care Act because it would have a devastating impact on the health of our nation’s most vulnerable citizens and make it more difficult to provide affordable health care for poor and low-income Americans.

The House today narrowly passed a revised version of the American Health Care Act (AHCA) by a vote of 217-213. The revisions included new amendments that were fashioned to appeal to both conservative and moderate members of the Republican majority.

A change which is being referred to as the Upton Amendment — named after the Congressman who introduced the new language — adds $8 billion to cover costs for the “risk pool” of persons with pre-existing medical conditions.

While the changes were successful in garnering sufficient votes to pass AHCA they did nothing to alleviate the devastating impact of AHCA on the nation’s most vulnerable citizens.  In fact, the bill passed today will likely exacerbate the challenge of providing affordable health care for poor and low-income Americans.

The following helps to explain why:

• The $8 billion in the Upton-Long Amendment is woefully insufficient to cover high-risk pools. According to the Center for Budget and Policy Priorities, over a 10-year period the $8 billion increase would not be enough to cover funding shortfalls for the states of Michigan, Missouri, and Colorado, let alone being able to take care of the risk pool shortfalls for the remaining 47 states.
• In its current iteration, AHCA allows states to choose to “opt-out” of covering pre-existing conditions of enrollees. In the states that choose not to guarantee coverage for pre-existing conditions, persons with life-threatening ailments, pregnant women, and older adults would have to pay exorbitant premiums for insurance coverage or not be able to obtain coverage at all. The AHCA segregates sick people in high-risk pools with those who are even sicker. In the past, such approaches have led to coverage with very high premiums, benefit exclusions, annual and lifetime limits, and other problems.
• The bill also decimates Medicaid allocations to states with more than $800 billion in budget cuts. This will deeply limit access to health insurance for individuals between the ages 55 and 64, younger people with disabilities, and children. We should be reminded that Medicaid subsidizes care for half of the children born in America in each year.
• The House version of AHCA continues to be committed to discontinuing Medicaid enhancements and Medicaid expansion after 2019. This will mean that most of the 31 states (and Washington, D.C.) that have ACA’s Medicaid expansion will soon drop it. The 11 million people who were covered through Medicaid expansion will likely become uninsured.
• In the face of the opioid overdose and suicide epidemics, it is essential there be equitable access to a full continuum of mental health and substance use disorder treatment services. Substance use disorders and mental illness should also be covered on par with other medical conditions.

The House passed their version of the AHCA without it being “scored” by the Congressional Budget Offoice (CBO). Therefore, we have no idea of the cost of this legislation.

More importantly, we do not have a CBO analysis of the human impact of the provisions in AHCA.

Without a doubt, the gutting of $800 billion from Medicaid will leave millions of single adults uninsured, as well as greatly reduced access to health care for millions of low-income children and their families.

We must now turn to the United States Senate to right the wrong caused by the House version of AHCA. NASW and other health care advocates must use their resources and energy to ensure the Senate strips out provisions in AHCA that are most devastating to vulnerable Americans.