Several painted tiles, pushed together to create a wall of artwork

AHCA Will Hurt People on Medicaid

WID News Analysis
May 22, 2017

AHCA Will Be Detrimental to People with Disabilities

Members of Congress recently passed the proposed American Health Care Act (AHCA) with the goal of repealing and replacing the Affordable Care Act (ACA or “Obamacare”). The proposed legislation, if enacted, would drastically harm Medicaid by reducing eligibility, creating work requirements, and moving from federal matching funds to “block grants” for funding. These changes will jeopardize the health care of people with disabilities across the country and reduce the quality of care for people who remain on Medicaid. The AHCA with all its Medicaid rules need to be stopped in its tracks – and the disability community should fight it nationwide.

Rolling Back the ACA’s Medicaid Expansion               

Medicaid is a health care program for poor, elderly and disabled residents that is run at the state level and uses a mix of state and federal funds to operate. It also is run using a mix of state and federal rules around eligibility, coverage and other means. Current rules allow Americans on Supplemental Security Income (SSI) due to disability and low income to receive full Medicaid coverage, and the ACA included a “Medicaid expansion” that has opened eligibility to people earning up to 133% of poverty, or around $16,080/year, in some states. People with disabilities have lower incomes and a higher rate of poverty than people without disabilities, and many may not receive SSI if they are doing some work or have a more limited disability, so a Medicaid expansion allows many in our community to have affordable health care and live safe lives.

Unfortunately, the AHCA would roll back this Medicaid expansion over the next several years and kick many people with low-to-moderate income off the program. Some research has found that people with lower income tend to work limited hours and are not eligible for employer health care, work with smaller companies that are not required to offer employer-covered health care, or otherwise work in industries that do not offer health care. This group also includes many people with disabilities, as they may have difficulty working full time or may have limited job opportunities. Medicaid provides vital health care for low-income people with disabilities in these situations – so reducing eligibility and kicking them off may eliminate their health care entirely. (This is especially true because under the AHCA, private insurers can charge much more for people with pre-existing conditions, so people who lose Medicaid likely won’t be able to afford private coverage at all.)

Work Requirements Target the Most Vulnerable

“Work requirements” will also create problems under the AHCA. The Affordable Care Act prohibited states from putting forward these requirements, which force Medicaid recipients who are deemed “able to work” to work a certain number of hours to keep their benefit. However, the AHCA will allow states to forego these requirements without any barriers. Research has shown that as of 2015, a full 59 % of Medicaid recipients who are able to work do, and 78% live in the household of somebody who does work. The rest may do informal and unpaid work, such as taking care of family members with disabilities or they may themselves have a disability that is not diagnosed or officially recorded and does prevent them from holding a regular job. People with disabilities likely make up a large share of Medicaid recipients who do not hold a job, so work requirements endanger this vital benefit.

A Bad Switch to Block Grants

The AHCA also changes how the federal government pays states from its current “matching funds” system over to block grants. Under the current rules, the federal government shares the costs with states: so for every $1 that states spend, the federal government reimburses them $0.50. Under block grants, though, the federal government gives states a fixed amount of money for their Medicaid program, and each state gets to decide how much extra it wants to spend, even if that is next-to-nothing. This is funded through a per capita system where funds are based or the number of Medicaid enrollees in each state. There are also block grants for certain populations or services which can vary state-by-state and be used to eliminate Medicaid coverage at many levels. These will combine to scale back the eligibility for Medicaid, as well as the services provided through Medicaid, as required and quality-of-care provisions will be taken away. This will affect all existing or potential Medicaid recipients in many states – and because people with disabilities have higher health-related costs, states may find ways to not cover vital health care services or just keep people with disabilities off the program entirely.

Speak Out Against the AHCA

The AHCA is extremely dangerous for people with disabilities. It jeopardizes the quality of coverage for our community and, for many of us, the ability to have health care at all. These three rules around Medicaid – rolling back the ACA’s Medicaid expansion, work requirements and block grants – will especially affect us, but there are plenty of others as well, such as the ability for insurance companies to charge more for pre-existing conditions, expanding the list of those conditions, and rolling back women’s health programs. However, AHCA has still not passed the Senate, and there are many opportunities to push back against its many problems. You can call your legislator, work with disability organizations, or even use social media to spread the word. So let’s fight for health care together and support our community’s right to health!

Main content end

Pre-existing Conditions Under the AHCA

WID News Analysis
May 22, 2017

The Affordable Care Act (ACA), also known as Obamacare, sought to do something revolutionary in the United States, which was to not only make health care available to everyone, but to simultaneously eliminate the negative impact that its predecessors had on people with pre-existing conditions, which disproportionately affected people with disabilities, those with low incomes, and women. Old forms of health care lumped people with pre-existing conditions together under a pre-existing conditions category, which ultimately led to high-risk pool placement and an array of associated high costs.

High-risk Pools

Historically, people placed in high-risk pools have had pre-existing conditions that were deemed too expensive by insurers. Pools offered exorbitantly-priced premiums, with insurers able to charge up to 200% above private individual market rates; annual and lifetime caps were placed on recipients’ medical expenses, and before people could receive care, most had to pay $1,000 or higher for their deductibles, and in some states, $5,000 or higher. People placed in high-risk pools are also often subject to annual and lifetime limits on their health care expenses, ultimately leaving them without the means to pay for their necessary health care expenses once they cap out.

Below is an image of a list of pre-existing conditions, such as cerebral palsy, paralysis, and muscular dystrophy; for a more comprehensive list, visit Kaiser Family Foundation’s website.

Graphic; List of examples of pre-existing conditions.

Fielding costs like these is a burden, particularly for people with low incomes, which overlaps with the portion of the population with disabilities. In 2015, 27% of people with disabilities lived below the poverty line in the United States; in Mississippi and New Mexico, it is higher than 33%.

Obamacare requires that everyone have health insurance or opt out and pay a fee; because of this model, people with low incomes who also have expensive pre-existing conditions can more comfortably afford care. The American Health Care Act (AHCA), also known as Trumpcare, proposes that the country regress to old forms of health care that separate people with pre-existing conditions from the rest of the market and drive up their costs so that people with fewer health care needs can save.

Backers of the AHCA claim that people with pre-existing conditions will be taken care of because states will be allotted two buckets of funds, one of which is specifically for people placed in high-risk pools, the second of which states can use as they see fit. However, the funds from the second bucket could potentially be transferred to the first bucket if needed; realistically, this money could run out or insurers could choose to charge high premiums and deductibles in order to avoid pulling from both buckets.

ACA Subsidies vs. AHCA Tax Credit

Currently, insurance subsidies or grants are available to people if they meet certain qualifications, one of the main ones being that the individual would have to be deemed ineligible for coverage through an employer or a government health care program for at least one month in the year. Another primary qualifier is recipients’ incomes must be at or below 100-400% of the federal poverty level. Under the AHCA (Trumpcare), people meeting these qualifications would receive a tax credit instead, which would not exceed $4,000 regardless of health status. Thus, a 60-year-old in the low-income bracket (around $20,000/year) with a pre-existing condition, who has significant health care needs, could see his or her aid drop by thousands of dollars.

Get Involved

The most vulnerable members of our society are in danger of losing essential health care, and it boils down to the new administration and its constituents wanting to save some money, rather than take care of all members of society. Whether it’s you or someone you know that may be affected by these changes to our health care system, the time to speak out is now.

Ways You Can Contribute

Hop on social media, share your story, and tag it with #IAmAPreexistingCondition. People with pre-existing conditions are sharing their stories all over the Internet with this hashtag, bringing to light how their needs are in danger of being set on the back burner.

Contact your state’s representatives. It is their job to represent you and your interests. You can find your representatives on the USA.gov’s elected officials page.

Main content end