How Odious Is the House-Passed American Health Care Act? Let Us Count the Ways It Hurts People With Disabilities.
& Susan Mizner, Disability Counsel, ACLU
Last week, 217 members of the House of Representatives voted to decimate our country’s safety net for people with disabilities. And many of them gleefully toasted its passage on the White House lawn with President Trump. Yet, on every front, the American Health Care Act (AHCA) threatens the civil rights, health, employment, freedom, and the very lives of millions of people with disabilities in every state across our country.
Now that the debate moves to the Senate, with so much at stake if this cruel bill passes into law, it’s worth taking a moment to really understand the ways the Obamacare repeal bill harms people with disabilities. There’s nothing to cheer or grin about here.
- Taking an Ax to Medicaid: According to the non-partisan Congressional Budget Office, the AHCA slashes $839 billion from Medicaid over the next 10 years. Medicaid currently works as a partnership between the states and the federal government, with each dollar from the state matched by an equal or greater federal investment. Federal dollars have allowed states to expand services to people with disabilities and address the needs of people with disabilities on waiting lists. Through “per capita caps,” the AHCA dramatically slashes future federal funding for Medicaid, limiting the ability of states to respond to the needs of their residents.
- Taking Our Lives and Our Freedom: For people with disabilities, Medicaid is more than just health insurance — it’s the main financing source for services like personal care attendants to help people get dressed, eat, and use the bathroom. These supports keep people with disabilities out of nursing homes and institutions. By cutting Medicaid by hundreds of billions of dollars over the next 10 years, the AHCA threatens to slash the supports that keep people with disabilities free from institutional care and send them back into nursing homes. Supporters of this horrible bill claim to care about our freedoms, yet they completely ignore that Medicaid provides the means for people with disabilities to leave institutions and exercise their constitutional right to liberty.
- Ending the Medicaid Expansion: The AHCA would end Medicaid expansion in 2020, forcing states to kick millions of people off of coverage and out of care. Medicaid expansion has allowed millions of individuals with disabilities, especially those with mental health needs or substance abuse problems, to access care. Medicaid expansion has also allowed many more people with disabilities to enter the workforce. The AHCA reverses this progress.
- Pre-Existing Condition Discrimination Is Back: Thanks to last-minute changes in the bill, states can waive Obamacare’s protections against pre-existing condition discrimination. This means that your state could allow insurance companies to charge you more money if you have a pre-existing condition like autism, depression, bipolar disease, etc. People with disabilities would certainly lose health insurance coverage because it would no longer be affordable.
- High Risk Pools Are Risky and Don’t Work: The awful AHCA includes funds for “high risk pools” to purportedly cover people with pre-existing conditions. Unfortunately, “high risk pools” have been tried repeatedly and have repeatedly failed for three main reasons: They impose premiums so high that most people cannot purchase the coverage. They cover only about half of the health care needed by the individual, and they impose life-threatening waiting periods. This latest effort underfunds risk pools by $200 billion — and it’ll be people with disabilities and others with chronic health needs left holding the bag.
- They’re Called “Essential” For a Reason: Under the Affordable Care Act, health insurance must cover “essential health benefits,” including doctors, hospital care, prescription drugs, pregnancy and childbirth, drug treatment, and mental health services. AHCA allows states to waive these requirements, enabling insurers to sell cut-rate plans that won’t pay for any real care when you need them.
- Annual and Lifetime Caps Are Back: The AHCA permits the resumption of annual and lifetime caps on coverage in states that waive essential health benefits and in large employer-provided plans, affecting more than 100 million Americans. This means that insurers can set limits on the total amount of benefits that a plan would cover in a year or in a person’s lifetime. Prior to the ACA, these caps were devastating to people with disabilities and their families. For example, a child with cystic fibrosis would be at significant risk of hitting a lifetime limit of $1 million before reaching adulthood. People with disabilities were often forced to delay vital medical procedures or prescription drugs due to annual limits on the amount of money the insurance company would pay. These are the days that AHCA threatens to return us to.
People with disabilities deserve better than this. Everyone does. And we will continue to fight to ensure that the American Health Care Act never becomes law. We have people power on our side and, despite our loss yesterday, our voices will not be silenced.
We must make clear to every member of the Senate that the monstrosity that came out of the House of Representatives is unacceptable. For millions of Americans with disabilities, the stakes are too high to do anything less.