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The Impact of the Proposed Republican Reforms to the Affordable Care Act

Americans have gotten their first glimpse of proposed Republican reforms to the Affordable Care Act (ACA) and the news is not good for those who suffer from addiction and other vulnerable populations. The changes could make it impossible for many who currently have access to care to get treatment in the future, reversing the progress made by the ACA. The result, if the changes pass Congress, will mean a loss of life.

There is some good news in the Republican proposal. Some of the most important and popular aspects of the ACA will be retained. These include: 1) Young adults up to the age of 26 will be able to stay on their parents’ healthcare plan; 2) There will be no return to lifetime caps on healthcare; 3) There will be no return to “pre-existing” conditions. These are critical healthcare reforms that protect those who have health insurance, especially those who access health insurance through their employers.

The proposed changes to the healthcare system mainly come in the area of funding: who can access health insurance and how it will be paid for. In this regard, the changes are less positive, particularly for the poor and the aging.

One aspect of the ACA under attack by Republicans is Medicaid expansion. Under Obama, many states were able to expand Medicaid coverage. Some of those states, like Ohio, are among those that have been hardest hit by the opioid abuse epidemic.

Medicaid is currently funded on a flexible basis. States are paid based on the number of poor who are covered through the program. When the economy lags or a state has an increase in the number of people qualifying for Medicaid for other reasons, the federal government increases funding to pick up the slack. Medicaid is a true safety net under this system.

The current administration wants to change Medicaid funding to a block grant system. With block grants, the federal government pledges a specific amount of money to each state. This amount does not change based on need and is re-evaluated at three year intervals. In times when the economy lags, it is likely that the federal government will decrease funding to states, rather than increase it as the current system does. Most block grant funded programs atrophy. As federal Medicaid funding becomes increasingly unavailable, states that are unable to make up the losses will have larger and larger numbers of people without Medicaid coverage.

Older Americans will also suffer under this proposed ACA revision. Caps on how much insurance companies are able to charge older adults will significantly increase and although tax credits will switch from assisting the poorest Americans to assisting older Americans, it is unclear that these tax credits will cover the skyrocketing premiums older Americans will face.

These changes to the ACA are not a foregone conclusion. There is opposition among the farthest right wing of the Republican party, medical doctors and hospital associations, and elder rights advocates. At present, the legislation could not pass the Senate. To retain your healthcare coverage and that of the most vulnerable Americans, let your Senator know where you stand and that you vote.