American Society of Hematology

ACA Update

Published on: March 21, 2017

As of March 21st, legislation, titled the “American Health Care Act” to repeal parts of the Affordable Care Act (ACA) has passed out of three key committees in the US House of Representatives – the Committee on Ways and Means, the Committee on Energy and Commerce, and the Budget Committee.  The legislation is scheduled for debate in the House Rules Committee Wednesday, March 22nd and then will be considered on the House floor as early as Thursday, March 23rd.  The Senate will consider the legislation if and when it is approved by the House.

This legislation does not repeal the ACA’s insurance coverage reforms, adult children can remain on their parent’s health insurance until age 26 and the prohibition on lifetime and annual limits remains.  And while insurers will still be required to cover individuals with pre-existing conditions, a new provision specifies that if any individual goes without coverage for more than 63 days, insurers are able to apply a 30 percent penalty to their premiums for 12 months.

The “American Health Care Act” does away with the ACA subsidies and replaces them with age-based tax credits, with limitations based on income, and if this legislation becomes law, insurers will be able to charge older Americans more for healthcare.  The ACA’s Medicaid expansion (which allowed states to cover childless men and women above age 19) would be repealed after 2020.  While the enhanced federal funding for Medicaid would remain in place until the expansion is formally repealed, the legislation would immediately prohibit states that have not expanded Medicaid from doing so.   Also, the AHCA will convert the Medicaid program to a per capita allotment or a block grant system – leaving the choice up to the states.  These changes would make it more difficult for states to respond to fluctuations in the price and demand for health care services.

The legislation repeals the controversial individual and employer mandates, as well as the tax provisions, which were included in the ACA to finance the coverage expansion.  Other than the penalty that would be imposed on those who do not maintain continuous coverage and the potential decrease in funds spent on Medicaid once it transitions to a per capita allotment or block grant system, it is not clear how the coverage expansion will be paid for.

As written, ASH has serious concerns that this piece of legislation will reduce overall access to coverage and treatment and would greatly impact patients with hematologic diseases and disorders. ASH shares the concern of many, that the repeal of the Medicaid expansion and moving Medicaid to a per capita allotment or a block grant system will cause many low-income individuals to lose their insurance coverage.  Medicaid coverage is critical for patients with sickle cell disease, an inherited chronic disorder affecting nearly 100,000 Americans who often experience lifelong complications including stroke, acute chest syndrome, organ damage, and other disabilities.

ASH is also concerned about the bill’s proposed elimination of the Public Health and Prevention Fund which has supported many critical projects at the Centers for Disease Control and Prevention (CDC), including investments in immunization and health-care associated infections. Currently the Fund comprises approximately 12 percent of CDC’s budget and should be preserved.

The Society is committed to ensuring that all individuals who need the services of a hematologist have access to one, and that patients have affordable and reliable coverage options so that the most appropriate and effective treatment options are available to them.  ASH will continue to monitor this process with respect to the impact on hematology practice.

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