AHCA puts health care out of reach for rural Alaskans

On May 4, the House of Representatives passed H.R. 1628, also known at the American Health Care Act of 2017, or AHCA for short. The bill has been introduced as a “repeal and replace” solution for current healthcare legislation, the Affordable Care Act, or ACA for short.
Last week, the Congressional Budget Office, CBO, released a cost estimate study of the AHCA, which explores the various components of the bill and how they affect not only the federal budget, but also the many insured or uninsured Americans across the nation.
According to the CBO, which worked together with the Joint Committee on Taxation to compile the report, “Enacting the AHCA would reduce federal deficits by $119 billion over the coming decade and increase the number of people who are uninsured by 23 million in 2026 relative to current law.”
The AHCA bill will still need to have a Senate version presented and approved, and most likely undergo various revisions before it hits the desk of President Trump. But as it stands now, in its current form passed by the House of Representatives, the AHCA would not only mean large premium increases for millions of Americans, but also a huge increase in costs for states like Alaska, especially regarding Medicaid.
“As we all know, repeal and replace – under the budget reconciliation process – cannot include every legislative fix needed to address the downward spiral of the Affordable Care Act or address all of Alaska’s unique needs,” said Congressman Don Young, who voted in favor of the house bill, in a statement.
“Although this bill is far from perfect,” continued Congressman Young, “I have made the very serious decision to move this process forward and continue the much needed debate to tackle our nation’s many healthcare challenges. Given the choice of doing nothing or moving forward on efforts to roll back the many destructive policies of Obamacare, I chose the latter.”
As the AHCA House bill focuses mainly on reducing overall healthcare costs for the government and giving more control to the states, the main cost-savings solution in the bill is to decrease federal Medicaid spending by more than $800 billion by the year 2026. Cutting this much Medicaid money at the federal level leaves the burden in the hands of the states.
For states like Alaska, which chose to expand Medicaid coverage under the ACA, costs of continuing that Medicaid coverage under the AHCA may become not just astronomical, but also unsustainable. According to a study by the Center for American Progress, an independent nonpartisan policy institute, 44,500 Alaskans would lose their health care coverage by 2026.
According to a May 22 report by AXIOS Media, an online news and information company, an analysis of cost increases by state shows that under the new ACHA, Alaska would see a 390 percent increase in Medicaid costs by 2020, rising from $21.4 million (under the ACA) to $107.2 million (under the ACHA).
 “Our numbers reflect that states that have expanded Medicaid to low-income adults under the ACA would face drastic cuts to federal matching funds for the program starting in 2020 and that expansion would no longer be a viable option by 2026 for states that have not already done so,” the Center for American Progress reported.
In the cost estimate by the CBO released last week, the 23 million Americans that could no longer afford healthcare coverage by 2026 would mainly be due to pre-existing conditions, which drew sharp criticism to the bill from organizations such as the American Diabetes Association, American Cancer Society, Cancer Action Network, American Heart Association, American Lung Association, Cystic Fibrosis Foundation, JDRF, March of Dimes, National Organization for Rare Disorders, National MS Society and WomenHeart: The National Coalition for Women with Heart Disease.
According to a May 1 press release from the American Diabetes Association, these ten nationwide organizations have come together to form a coalition that stand united in their opposition of the ACHA.
The release states, “As introduced, the bill would profoundly reduce coverage for millions of Americans—including many low-income and disabled individuals who rely on Medicaid—and increase out-of-pocket costs for the sickest and oldest among us. We are alarmed by recent harmful changes to the AHCA, including provisions that will weaken key consumer protections. These changes include allowing states to waive the requirement for essential health benefits, which could deny patients the care and treatment they need to treat their conditions.”
Skepticism of the house bill is being shown not only from nationwide organizations, but also from U.S. Senator Lisa Murkowski.
According to Communications Director Karina Petersen for Senator Murkowski’s office, the Senate is working on a different version of the bill, which is why Murkowski has not commented at length on the current House bill.
“With that said, Senator Murkowski does have concerns with the House’s healthcare reform bill —which was reaffirmed when the CBO score came out this week — that it leaves more people uninsured and doesn’t offer coverage that is affordable for communities that are already struggling,” reported Petersen in an email to The Nome Nugget.
 With high premiums and high costs being one of the unique challenges for Alaska, the AHCA would disproportionately hurt rural areas across the state. In some cases, the annual cost of health care would exceed a person’s annual income.
According to a study released last month by the Henry J. Kaiser Family Foundation, “People who are older, lower-income, or live in high-premium areas (like Alaska and Arizona) receive less financial assistance under the AHCA. Additionally, older people would have higher starting premiums under the AHCA and would therefore pay higher premiums.”
Using an interactive map feature on the Kaiser Foundation website, various income brackets can be examined by state and country to see the change in premiums under the current ACA versus the proposed AHCA for the year 2020.
For example in Nome, a 40-year-old making around $30,000 per year can expect a yearly premium of $1,910 in the year 2020 under the current ACA. That same person would see their premium increased to $10,430 under the AHCA, a rise of 444 percent.
The increase in premiums becomes only worse with the advanced age of the insured. Under the ACA, by the year 2020 a 60-year-old making $30,000 per year sees the same premium as a 40-year-old: $1,910 annually. But under the AHCA, that 60-year-old insured person can expect their premium to exceed their annual income, coming in at $34,330 annually, or an increase of 1694 percent.
According to the CBO’s cost estimate report, “Community-rated premiums would rise over time, and people who are less healthy (including those with preexisting or newly acquired medical conditions) would ultimately be unable to purchase comprehensive non-group health insurance at premiums comparable to those under current law, if they could purchase it at all—despite the additional funding that would be available under H.R. 1628 to help reduce premiums.”

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