A Health Care Foundation series: Exploring #RepealAndReplace

I have been reading so many opinions and analyses of the recently proposed American Health Care Act. 

In some of the more nuanced discussions, people differ on what it will and won’t do.

I think we can be certain that everyone involved recognizes that health care and insurance is complicated and that solutions for one are penalties for others.

Our focus at the Health Care Foundation has always been on those at the highest risk of being left behind when it comes to health opportunities. We have celebrated, in the last several years, steady gains in insurance coverage. That was done through targeted and steady outreach, community engagement and the financial supports provided in the Affordable Care Act.

 We also have noted the challenges for those who have struggled with high-deductible plans that have been increasing over the last 15 years. Underinsurance is a real problem for patients and providers alike. Surveys show that, even with the high-deductible plans, people value being insured. Our focus groups with Medicaid recipients also confirmed that people deeply value the ability to get health care when needed. 

The other truth is that we need many voices to create and craft what is a solution to a complex problem. It would be easy to be paralyzed by the enormity of the issues but these are real issues that affect real people, real businesses and real budgets. It will take many thoughtful and listening people to craft a way forward.

Over the coming weeks, as the House debates and ultimately votes on this bill, Health Forward will continue to explore this proposed legislation and its impact on our community.

Here’s a brief overview of the American Health Care Act:

What stays
Popular provisions like allowing children to stay on their parents’ insurance plans until age 26 and requiring insurers to accept everyone regardless of pre-existing conditions will remain in the proposed legislation.

What goes
It would repeal the individual mandate. It would also eliminate a slew of taxes included in the ACA including the medical device tax, the tanning tax, a tax on high earners and a tax on investments that helps pay for the ACA.

What changes
The new bill would shift how Medicaid is funded from its current, open-ended federal matching payments to a per capita cap. It would also offer financial support to states that didn’t expand Medicaid under the ACA by making a series of funding changes and reinstating disproportionate share hospital payments.

The existing tax credits or subsidies would be replaced by different tax credits. Republicans would replace Obamacare subsidies with new, age-based tax credits ranging from $2,000 to $4,000 to help individuals pay for coverage.

What’s the impact for our community?
In our six counties, this is what increases will look like as they decrease premium support. A 27-year-old adult who makes $75,000 will go from no support to $2000 credit per year to purchase insurance. Low-income adults and those over 60 really suffer as you can see below.  

For a 60 year old with an income of $20,000
Missouri Previous premium support in dollars Amount of new tax credit Percentage decrease in premium support
Jackson $9,480 $4,000 -58%
Lafayette 14,560 4,000 -73%
Cass 9,480 4,000 -58%
Clay 9,480 4,000 -58%
Platte 10,890 4,000 -63%
Johnson $10,890 $4,000 -63%
Wyandotte 10,890 4,000 -63%
Allen 9,430 4,000 -58%

Any changes made to current health care laws should focus on protecting and expanding quality coverage to thousands of hardworking Kansans/Missourians who are uninsured, as well as improving quality and value.

In the upcoming weeks, we will be running a blog series that examines the proposed changes from many angles. Please sign up for our weekly email to follow the series.



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