American Society of Hematology

ACA Update

Published on: May 05, 2017
Updated on: May 05, 2017

On May 4th the U.S. House of Representatives passed the American Health Care Act (AHCA), legislation to repeal parts of the Affordable Care Act (ACA).  The legislation will now advance to the Senate where further changes are likely to be made. ASH is opposed to the AHCA because of concerns that this piece of legislation will reduce overall access to coverage and treatment and would greatly impact patients with hematologic diseases and disorders.

After Congress failed to pass the legislation in late March, additional amendments were added to the AHCA. The changes include an amendment, introduced by Representatives MacArthur (R-NJ) and Meadows (R-NC), which allows states to apply for waivers to opt out of certain ACA requirements.  States could waive the regulation requiring all insurance products to cover the Essential Health Benefits, which includes basic benefits, such as hospital care and prescription drugs.  Furthermore, states could opt out of community rating, allowing insurers to charge higher prices to individuals with pre-existing conditions, and age rating, which would allow insurers to charge more to older Americans.  For states that choose to take waivers, an additional amendment, introduced by Representative Upton (R-MI), was included to help protect those with pre-existing conditions. The amendment adds an extra $8 billion over five years to the high-risk pools, which were previously funded at $130 billion under the original AHCA legislation.  These high-risk pools are meant to help with premiums and out-of-pocket costs for individuals with pre-existing conditions.  However, many health policy experts agree that the additional $8 billion will not be enough to cover those in need.

The “American Health Care Act” does away with the ACA subsidies and replaces them with age-based tax credits, with limitations based on income.  The ACA’s Medicaid expansion (which allowed states to cover childless men and women above age 19) would be repealed after 2020.  While the enhanced federal funding for Medicaid would remain in place until the expansion is formally repealed, the legislation would immediately prohibit states that have not expanded Medicaid from doing so.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.

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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