By: Michael Campbell, News Editor
VIRGINIA – Just over 100 days into his term in office, President Donald Trump joined Republican members of the House of Representatives in the Rose Garden of The White House Thursday following their passage of legislation that seeks to repeal and replace The Affordable Care Act, also known as Obamacare.
The measure passed largely along party lines Thursday afternoon by a vote of 217-213 and now heads to the United States Senate for consideration.
In terms of Virginia’s representatives in the House, six of the Commonwealth’s Congress members voted in favor of the American Health Care Act, or AHCA, while five voted against the bill.
Third District Democratic Congressman Bobby Scott, who represents parts of the Tri-Cities, Prince George and Surry, and Fourth District Democratic Representative Donald McEachin, who serves the communities of Dinwiddie, Prince George, Sussex and Surry, both voted against the AHCA.
According to House Republicans, the American Health Care Act “delivers relief from Obamacare’s taxes and mandates that have hurt job creators, increased premiums, and limited options for patients and health care providers.”
As part of the bill, the tax penalty for not having minimum essential coverage would be eliminated, instead, according to the Kaiser Family Foundation, a provision would be enacted that would allow insurance companies to charge customers a 30 percent late enrollment penalty for people who have not maintained continuous coverage.
A provision of Obamacare that allowed dependent children to stay on their parents’ health insurance plans until the age of 26 remains part of the AHCA, with the exchanges, or marketplaces, where consumers currently purchase health insurance through the ACA, also continuing under the AHCA.
Tax credits that are used to subsidize premiums would be eventually replaced with a flat tax credit adjusted for age, with those monthly credits starting at $2,000 per individual up to age 29 to $4,000 per individual for those aged 60 years or older.
This bill also would reduce the penalty for those large employers who do not provide health benefits to their employees to zero, retroactive to January 1, 2016.
Leading into the vote, the conversation around the AHCA’s impact on those with pre-existing conditions saw the bill looking at possible defeat for the second time in less than two months, but amendments to the bill sought to address those concerns.
According to House Republicans, The Upton-Long Amendment would “dedicate $8 billion solely to reduce premiums and other out-of-pocket costs for patients in the individual market with pre-existing conditions who do not maintain continuous coverage and who live in states that receive a waiver to redesign their insurance market,” with the MacArthur Amendment “explicitly maintaining protections for pre-existing conditions” by making it so any states that seek to apply for a waiver from federal regulations that could increase insurance premiums must prove that the waiver is being used to “reduce the cost of health care or increase the number of people with health care coverage.”
“The amendment specifically clarifies that its provisions cannot be construed as allowing insurers to limit coverage for those with pre-existing conditions,” Republicans said. “All of these protections will remain the law.”
They went on to say that the $8 billion as part of the Upton-Long Amendment is on top of $130 billion that would be available through the AHCA’s Patient and State Stability Fund, adding that states can use the funds to cut out-of-pocket costs, like premiums and deductibles, promote access to preventive services, such as annual checkups, dental and vision care, and “promote participation in private health insurance or to increase the number of options available through the market.”
The AHCA would also bring Medicaid expansion to an end, which has been a point of concern for leaders in the Commonwealth as the state grapples with the ongoing opioid epidemic, which officials pointing to concerns about access to vital substance abuse resources through the program.
While House Republicans said that an “additional $15 billion” would set aside specifically for “maternity care, mental health, and substance abuse treatment,” some officials, like Virginia Attorney General Michael Herring don’t think it will be enough.
“As Virginia families and communities face a devastating heroin and opioid crisis, this horrible bill would decrease coverage for recovery and treatment,” the attorney general said in a statement. “Over 1,100 Virginians died of a drug overdose just last year, and any bill that makes it more difficult to address this epidemic and help Virginians get treatment is dangerous and irresponsible.”
According to data from the Kaiser Family Foundation, over 400,000 Virginians signed up for insurance coverage through the marketplace during the 2017 Open Enrollment period.
Other representatives both on Capitol Hill and in Virginia expressed their concern over the bill’s passage without a report from the Congressional Budget Office on this version of the AHCA.
In March, the CBO reported that the original version of the bill that was presented to the House and later failed to receive enough support estimated in 2018 that “14 million more people would be uninsured under the legislation than under current law,” stemming from the repeal of penalties under the individual mandate.
Citing additional changes to subsidies for insurance purchased in the nongroup market and the Medicaid program, the number of uninsured relative to the current law is projected to rise to 21 million by 2020 and 24 million by 2026.
“The reductions in insurance coverage between 2018 and 2026 would stem in large part from changes in Medicaid enrollment—because some states would discontinue their expansion of eligibility, some states that would have expanded eligibility in the future would choose not to do so, and per-enrollee spending in the program would be capped,” the CBO report stated.
That was a motivating reason for Congressman McEachin’s decision to vote against the bill.
“House Republicans chose to pass a bill that would withdraw health coverage from 24 million Americans in order to fund massive tax cuts for the wealthy,” he said in a statement following the vote. “It would greatly increase premiums and out-of-pocket costs while making drastic cuts to Medicare. This bill would undermine existing protections for those with pre-existing conditions — and would open the door to other indefensible, potentially fatal limitations on coverage that I thought we had left behind.”
McEachin said he is prepared to work with his colleagues on both sides of the aisle but he said, “but I cannot and will not support this deceptive, dangerous attempt to turn back the clock and deprive Americans of the health care they need and deserve.”
“This bill will make life harder, and shorter, for vast numbers of Americans,” he continued. “No one chooses to have health issues. No one chooses a pre-existing condition. Good health is a blessing and we should not punish those who don’t have it. All Americans deserve affordable, quality health care.”
For House Republicans, on the subject of the CBO’s report, they said that the organization “has a spotty track record when it comes to projecting health insurance coverage,” adding, “When CBO originally scored Obamacare, they projected that 21 million Americans would have coverage in 2016. The reality was half that number, about 10.4 million gained coverage.”
According to the Centers for Medicare and Medicaid Services, at the time when Open Enrollment for 2016 coverage ended, “about 12.7 million plan selections” were made through the Health Insurance Marketplaces.
Outside in the Rose Garden, President Trump was confident that the bill would pass through the United States Senate.
“We’re going to get this passed through the Senate,” he said, remarking later that it will be “an unbelievable victory” when it moves through the Senate.
He also tried to assure Americans that deductibles and premiums would drop thanks to the legislation.
“And I think, most importantly, yes, premiums will be coming down,” the president said. “Yes, deductibles will be coming down. But very importantly, it’s a great plan. And ultimately, that’s what it’s all about.”
The bill now moves to the United States Senate for further consideration.