Tuesday, March 7, 2017

Action Alert: ACA Replacement Bill Slashes Medicaid

from National Council for Behavioral Health :
Yesterday evening, the U.S. House released legislation to repeal and replace the Affordable Care Act (ACA). The bill contains provisions that, if enacted, could devastate Americans’ mental health and addiction coverage and care. NOTE that this bill pays for reforms in the commercial health care market by dramatically cutting funding from Medicaid, the single most important funder of mental health and addiction services in this country. The bill is scheduled for a hearing in the House Energy and Commerce and Ways and Means Committees this Wednesday. See below for a summary of the bill and information on how you can join The National Council in fighting these potentially dangerous measures.

American Health Care Act Summary

Refinances Medicaid Into Per-Capita Caps – Fundamentally changes Medicaid financing from an open-ended federal and state matching formula into per capita allotments. Under this new system, the federal government would provide a set dollar amount to states based on its number of Medicaid enrollees. Per capita caps would start in FY 2020 and use each state’s spending in FY 2016 as the base year to set targeted spending for each enrollee category (elderly, blind and disabled, children, non-expansion adults, and expansion adults). The federal caps would only increase each year by the percentage increase in the medical care component of the consumer price index. This proposed growth rate is even lower than what was included in previous version of the bill, putting even more fiscal pressure on states. The goal of this proposal is to massively cut federal spending for Medicaid, potentially leaving millions without needed care.
Restricts Medicaid Expansion – After Jan. 1, 2020, the bill will allow states to continue to receive the enhanced FMAP rate for unique expansion individuals as long as they do not have a break in eligibility for more than one month. The enhanced federal matching rate would only apply to expansion-eligible individuals already enrolled in Medicaid as of Dec. 31, 2019. After Jan. 1, 2020, states could only enroll newly eligible individuals at the state’s traditional FMAP for that individual. Non-expansion states would be provided $10 billion over five years as safety-net funding to adjust Medicaid provider payments; Repeals state option to expand by Dec. 31, 2019This provision ends the growth of Medicaid expansion and slowly reduces the current Medicaid expansion population, who frequently break in and out of Medicaid eligibility
Repeals EHB Requirement for Medicaid – Repeals the requirement that essential health benefits (EHB) must be provided in certain Medicaid plans on Dec. 31, 2019. Essential health benefits specifically require health plans to cover mental health and addiction treatment. By removing the EHB for Medicaid, this provision puts Medicaid enrollees at risk of losing mental health and addiction treatment coverage. 
Repeals ACA Subsidies, Creates Refundable Tax Credits – Repeals the ACA’s cost-sharing subsidies in 2020 and creates an advanceable, refundable tax credit for the purchase of state-approved, major medical health insurance. Credits are not universal and are based on age and income-eligibility. Credits – ranging from $2,000 to $4,000 per individual - are available in full to those making $75,000 per year ($150,000 for joint filers). They phase down by $100 for every $1,000 in income higher than those thresholds. The repeal of the ACA’s subsidies limit affordable health coverage options for individuals with mental illness and/or addictions that do not have access to employer-based coverage. 
Maintains Popular Provisions of ACA – Preserves requirement for insurers to accept all consumers regardless of pre-existing conditions and allows children to stay on their parents' insurance plans until age 26. 
Repeals the Individual Mandate – Repeals the ACA's individual mandate and instead allows insurance companies to charge a 30 percent surcharge if consumers go without “continuous” insurance coverage for two months or more. 
Eliminates a Number of ACA Taxes – Eliminates the medical device tax, the tanning tax, a tax on high earners and a tax on investments. Again, these provisions are financed by dramatic cuts to funding in Medicaid.
See the bill text and the summary from the Energy & Commerce Committee.
See the bill text and the summary from the Ways & Means Committee.
For a comprehensive summary of all changes included in the American Health Care Act, click here


Now is a critical time to contact your members of Congress. The National Council is calling upon its members to join fight to protect Medicaid. Find out how by going to our Unite for Behavioral Health (Unite4BH) page.

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