Millions of Florida children and families would still face higher health care costs and lose coverage

LAKE MARY, FL – The Florida Policy Institute (FPI) today urged the U.S House of Representative’s Florida delegation to reject an “amended and compromised version” of the American Health Care Act (AHCA), otherwise known as the Affordable Care Act (ACA) “repeal and replace” legislation. The modified AHCA is reportedly even more harmful than the original version.

U.S. House Leadership may soon push for a vote on the amended bill.

“There was a tremendous outcry from constituents across the nation back in March. As a result, the harmful American Health Care Act was pulled from the floor,” said Joseph Pennisi, executive director of FPI. “But the reported amendment manages to make a bad bill even worse, putting the lives of the sickest and most vulnerable residents at risk. If representatives have the best interests of their constituents at heart, they will reject the amended legislation.”

The fundamental and underlying damaging features of the original bill are still intact. Accordingly:

• 24 million Americans would stand to lose health care coverage by 2026, eliminating all the coverage gains under the ACA;

• $839 billion in Medicaid funding would be cut over the next 10 years; and

• Middle-aged and older Americans would see a dramatic spike in premiums and out-of-pocket costs. These costs would disproportionally affect Florida, which has a large and growing population of seniors.

The reported amendment would make the severely flawed bill even worse by adding two harmful provisions.

First, the legislation would effectively eliminate the fundamental protections afforded by the ACA to people with pre-existing medical and health conditions. The “community rating” provisions of the ACA prohibit insurers from charging people higher premiums based on such pre-existing health and medical conditions as HIV/AIDS, asthma, diabetes, obesity, cancer, mental health issues or substance abuse problems.  In contrast, the amendment would allow states to request a waiver to ACA’s community rating requirements if they create or participate in a federal High Risk Pool. Even though the amendment would not allow denial of coverage for pre-existing conditions altogether, it would expose people with pre-existing conditions to prohibitively expensive, exorbitant premiums. It would also enable coverage exclusions for hospitalizations, prescription drugs or other basic health services.

The High Risk Pool, an alternative to the community rating system, has already proved to be ineffective, resulting in enrollment and benefit caps, long waiting lists, unaffordable premiums, high deductibles and annual and lifetime caps.

According to conservative estimates made by the Kaiser Family Foundation, at least 26 percent of Floridians under age 65  — 3.1 million — had a pre-existing health condition in 2015 (the most recent year for which data were available). These individuals would likely be declined if they sought coverage in the individual market under pre-ACA medical underwriting practices.

This would result in a regression to the pre-ACA era, where insurers have unrestricted premium assessment rights and the ability to institute discriminatory health insurance coverage provisions based simply on medical history and pre-existing health conditions, unless the state choses to prohibit such practices. Further, because the AHCA stands to sharply increase premiums and out-of-pocket costs for consumers by eliminating the individual mandate and slashing subsidies, states would be under intense pressure to seek waivers under this proposed amendment.

Second, the reported amendment would eliminate the other most crucial protection of the ACA -essential health benefits. The ACA requires individual and small-group market health plans to cover key services such as mental health and substance use disorder treatments, maternal care services, prescription drugs and inpatient and outpatient care services.

In contrast, the amended AHCA would allow states to request waivers to these essential health benefits, which would incentivize insurers to drop coverage for people in need of expensive services such as mental health or cancer treatments, discouraging enrollment, particularly among sicker and high-cost individuals who need care the most.

This amendment would also likely re-institute a system of gender-based discrimination, in which women would be charged higher premiums than men for coverage and services such as maternity care.

Under the amended AHCA, states would receive automatic approval for their waiver applications by simply attesting that the requests are intended to lower premiums, improve coverage levels or “advance another benefit to the public interest.”

“The Florida Policy Institute urges the Florida delegation to oppose both the amendments and the AHCA in its entirety. The focus should instead be on genuine improvements to the Affordable Care Act, and expanding Medicaid for the more than 500,000 Floridians stuck in the coverage gap who remain uninsured,” added Pennisi.

The Florida Policy Institute is an independent, nonpartisan and nonprofit organization dedicated to promoting widespread prosperity through timely, thoughtful and objective analysis of state policy issues affecting economic opportunity.