Last week the House passed a bill to repeal and replace Obamacare by a vote of 217-213. Twenty Republicans and all Democrats voted against the bill. The bill replaces the ACA subsidies that help lower income people buy health insurance with a tax credit based on age that will help lower and middle income people buy insurance. The funding for Medicaid expansion that has helped 14 million low income people in 31 states obtain healthcare would be cut back by $800 billion. Obamacare taxes on the wealthy would be repealed.
In order to gain more support the bill, the final version allows states to opt out of certain regulations including one that requires insurers to provide essential benefits including mental health benefits. That becomes optional and subject to cost concerns. Another now-optional regulation applies to pre-existing conditions, allowing insurers to use "health status" -- that is, current health, health history and other risk factors -- to set insurance premiums. Insurers could, based on your health status, offer you a policy that comes with an exorbitant rate. Concerns about this were addressed by amending the bill to add $1.6 billion per year to the pool states can use to cover these higher costs, or $5 per American.
School superintendents, who rely on $4 billion a year in Medicaid money to hire staff and provide services to children with disabilities, say the bill’s cuts to Medicaid could hamper their ability to employ nurses, social workers, occupational therapists and counselors, and to offer services such as hearing and eye tests.
The American Counseling Association opposed this bill because it is very likely to reduce mental health coverage and it does not need to. It does do the following:
- Caps spending on Medicaid, with which a significant portion of our members’ client base is able to afford counseling.
- Allows insurance plans to no longer offer essential benefits that include mental health services.
- Cuts funding for substance abuse programs.
- Is projected to result in 24 million Americans losing health insurance who currently have it.
There is no official cost/benefit analysis of the latest version of this bill because the House voted on it before the Congressional Budget Office finished the analysis. The bill now goes to the Senate, which has a different set of priorities and a smaller Republican majority. The Senate will rewrite and replace most of the House bill, and any bill that passes in the Senate will look significantly different from it. Then the two bills will likely go to a conference committee where the two different versions would have to be combined into one bill that can again pass both the House and Senate. That will be a difficult objective to meet.
Stay tuned to ACA Connect and the ACA website for more news and updates regarding healthcare legislation in Congress.
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