On May 4, the U.S. House of Representatives voted 217-213 to pass the American Health Care Act (AHCA) (H.R. 1628), legislation to repeal and replace portions of the Affordable Care Act (ACA).
After failing to amass enough votes to pass the House in March, the legislation was modified to address concerns from conservative and moderate Republicans who did not support the original bill. Most notably, the new version of the legislation allows states to waive certain ACA provisions, including minimum coverage and protections for pre-existing conditions. Three amendments, including a $15 billion risk-sharing program; state waivers of essential health benefits and certain components of community rating; and a last minute amendment which would provide $8 billion from 2018-2023 for states that receive a community rating waiver to reduce premiums and cost-sharing for impacted individuals, were adopted through the vote.
The legislation continues to cap Medicaid funding for states, removes the individual mandate to purchase health insurance, and changes premium support for individual health insurance from an income- to an age-based system. On May 24th, the non-partisan Congressional Budget Office (CBO) projected that the bill as passed by House would result in 23 million fewer people covered by 2026, 14 million of which would result from $834 billion in cuts to the Medicaid program over 10 years. In New York, up to 2.7 million individuals could be at risk of losing coverage under the bill, and the state could lose as much as $6.9 billion in federal Medicaid funding.
The bill will now move to the Senate, where it faces significant challenges and will likely undergo substantial changes.
Our Advocacy Efforts
Since the AHCA’s introduction, University leadership and the Office of Government and Community Relations have been actively expressing our concerns with the effects various proposals to repeal and replace the ACA, and the AHCA, once introduced, and have been in regular contact with our Congressional delegation regarding the implementation of the ACA. The University is deeply concerned by the impact the AHCA will have on patient coverage, including deep reductions to New York State’s Medicaid program and providers’ capacity to ensure access to needed services. University and Medical Center leadership will continue to work closely with our Congressional delegation and other state and national partner organizations to urge the Senate to restart and reset the discussion around health care in a manner that extends coverage to those who need it and ensures that the most vulnerable are not left behind.
On June 27, at the request of Governor Cuomo, URMC hosted a roundtable discussion with local experts on the House and Senate’s proposals for repealing and replacing the ACA. The panel included representatives from the NYS Department of Health, UR Medicine, Lifespan, Common Ground Health, the Rochester Regional Healthcare Association, Jordan Health, SEIU/1199, and citizens who have benefited from the ACA. Donna Frescatore, Executive Director of the New York State of Health, described how the House and Senate legislation could impact New York State. The slides from her presentation are available here.
Statements on the American Health Care Act (AHCA)
The University and several of our associations have issued statements on the AHCA:
Repeal and Replace Legislation in Congress: An Update from URMC CEO Dr. Mark Taubman
UR Medicine Statement on the AHCA
Children’s Hospital Association Statement
In January, the UR Medicine hospital CEOs sent a letter to our Congressional delegation urging a careful and thoughtful process for repealing and replacing the Affordable Care Act (ACA) that is comprehensive and simultaneous. Failure to do so would threaten coverage to millions of New Yorkers, destabilize insurance markets, cause a fiscal crisis for the state and localities, and profoundly undermine the ability of providers such as UR Medicine to transform care and provide accessible quality care for all.
In March, UR Medicine sent a letter in follow-up stating that after careful evaluation and review of hospital-specific analysis of the AHCA, UR Medicine determined it could not support the AHCA in its current form, and urged the Rochester area Congressional delegation to oppose the bill.
- On June 27, a group of nearly 20 higher education associations, led by the American Council on Education (ACE), sent a letter to Senate Majority Leader McConnell and Minority Leader Schumer about the impact the Better Care Reconciliation Act will have on universities, teaching hospitals and academic medicine, and students’ access to health care.
- On June 15, the UR Medicine hospital CEOs sent letters to both Senators Schumer and Gillibrand outlining our deep concerns with the AHCA and the impact it would have on UR Medicine and the Finger Lakes and Southern Tier regions. The letter thanks both our Senators for sharing our concerns and their leadership in opposition to the consideration of the AHCA or AHCA-like legislation in the Senate.
- On April 21st, HANYS sent a letter to the New York State Congressional Delegation on behalf of its membership, expressing its opposition to the AHCA, citing deep concerns with the bill’s projected impact on coverage, the State of New York’s Medicaid program, and health care providers.
- On March 20th, the NYS Allied Association, representing HANYS, GNYHA, Suburban Hospital Alliance, Western New York Health Care Association, Iroquois Healthcare Alliance, and the Rochester Regional Healthcare Advocates sent a letter to New York State’s Congressional Delegation strongly opposing the AHCA, noting severe harm to insurance coverage, Medicaid program, state budgets, and hospitals and health systems.
- On March 8th, a coalition of seven associations representing hospitals and health systems, including AHA, AAMC, and CHA, sent a letter to Congress expressing significant concerns with the AHCA and the substantial reduction in affordable coverage for patients that would likely result from its passage
- In December 2016, the AAMC sent a letter to then-President-elect Trump and Vice President-elect Pence on behalf of the nation’s medical schools and teaching hospitals to urge the Administration and Congress to adhere to several key elements to reforming the ACA, including pursuing comprehensive reform to ensure a meaningful replacement that maintains affordable coverage; maintaining the Medicaid expansion; and the inclusion of health care stakeholders in development of any reform package.