On Thursday, the American Health Care Act, a bill designed to repeal and replace the Affordable Care Act, narrowly passed the House of Representatives. The vote was 217 to 213. The day was President Trump's 105th in office—the same day he signed a new "religious liberty" executive order, which, as critics have noted, could act to legalize anti-LGBTQ discrimination and threaten to further infringe on civil rights.
It’s a lot to digest in a single day, and between the bureaucratic terminology, political rhetoric and budgetary projections, it's difficult to understand what it all means in the context of our own lives. We have questions, and you might too. So we tried to answer a few of them.
So how is this healthcare plan different from the old one? Deep breath. It's really different but equally convoluted. We'll try to keep it simple.
The new AHCA bill would essentially loosen federal requirements turning more power over to states. Depending on where you live and your age, your premiums could skyrocket or possibly drop. (Check out this interactive map that predicts your likelihood for either scenario.)
Instead of your income dictating your eligibility for insurance subsidies, you'd receive tax credits. 20-somethings might receive $2,000 in credit while those over 60 could get up to $4,000—which is something, but not a lot, considering the potential for increased premiums under the revised plan.
Wait, how would insurance premiums change? States would be allowed to apply for waivers on federal regulations that protect individuals. That means premiums for older people and those with pre-existing conditions could spike. (More about pre-existing conditions a little later.) It also means that basic benefits wouldn’t necessarily include emergency and maternity coverage, which are currently required by the ACA.
What's all this business about Medicaid? While the bill would slash taxes imposed on insurance companies and those who earn over $200,000 a year, it would also reduce coverage options for those teetering above the poverty level.
Enter Medicaid—the federal coverage program for low-income individuals and those with disabilities. Under the AHCA, the program would function through grants distributed to states, so your coverage allotment would depend on where you live and how your state doles out the funding. Under the ACA, the program is supposed to expand its coverage to more individuals living slightly above the poverty line. The new measure would roll back those plans.
Would you still be penalized for opting out of coverage? Yes, but in a different way. While the bill would kill the tax penalty for the uninsured, it would also allow insurers to raise your premium by as much as 30 percent if you had a gap in coverage.
What if you're already covered by your employer— could the new bill actually impact you? Sure could, according to analysts. The new measure would loosen requirements imposed on insurance companies, which means that your own company might lower their premiums by choosing an employee plan that doesn’t cover the basics—like ER visits and maternity care.
What are pre-existing conditions and why is everyone talking about it? The US Department of Health and Human Services defines it as a "health problem you had before the date that new health coverage starts." Really, it's the loophole insurers can use to raise premiums and decline coverage to individuals.
Right now, the ACA regulates those premiums and requires companies to accept anyone who applies for coverage. The new bill would kill those regulations, allowing companies to deny coverage to millions of Americans. (The trending Twitter hashtag #IAmAPrexistingCondition is more evidence of how many of us there are.) The list of so-called conditions could encompass everything from mental illness to diabetes, cancer, and pregnancy. Survivors of sexual assault and domestic violence are also at risk of having their trauma labeled "pre-existing"— ultimately discouraging victims from seeking help out of fear they’ll be penalized by insurers.
The bill would also deny coverage to transgender people. In 2010, the ACA banned federally-funded health care providers from refusing to treat patients on the basis of race, age, disability, sexual orientation or gender—making it illegal, for the first time in this country, to deny treatment to transgender individuals. The new measure would kill that clause.
Sarah Kate Ellis, president and CEO of GLAAD, warned that the bill "could strip away health insurance from millions of Americans, including many in the LGBTQ community," adding that “health care is a human right, and no one should be denied access to care because of a preexisting condition or because a program like Planned Parenthood does not fit the ideology of one political party.”
As Ellis mentioned, the bill would also reduce funding for Planned Parenthood by an estimated half a billion dollars in the first year, effectively limiting even more health care options for underserved individuals.
What’s more, Trump's executive order on Thursday, which coincided with the healthcare reform vote, could allow religious institutions to override the ACA’s birth control coverage, and risks legalizing LGBTQ discrimination, infringing on all our civil rights.
So now what? The AHCA bill moves to the Senate, where it’s expected to undergo several changes and face a tough crowd when it comes under the microscope (reports suggest that's sometime in June).
That's it? We just have to wait around as our future hangs in the balance? Shush your mouth. If you’re concerned about the state of things, there are actions you can take. You can call your senators. Activist sites like Party Lines and apps like 5Calls are already providing healthcare-related outreach tools—from phone numbers to scripts, which make voicing your concerns a lot easier. You can also sign and share online petitions to uphold the ACA, and support organizations providing health and human rights protections to vulnerable communities. Finally, you can stay informed. Knowledge is power, and every single voice can effect change—or halt it.