AHCA Jeopardizes Primary Care

Categories: Policy

It’s a promise made and kept: the House of Representatives under pressure from President Trump voted to repeal the Affordable Care Act and replace it with the American Health Care Act (AHCA). This piece of legislation is profoundly dangerous to 24 million people whose coverage is in jeopardy, more than 50 million people with preexisting conditions, and 60 million older adults who would see their premiums rise dramatically. It would also jeopardize the financial stability of the primary care providers who serve our communities.

The AHCA was passed with a stunning lack of debate and without a cost estimate by the Congressional Budget Office. Far from a bi-partisan effort, this Act is not a thoughtful policy initiative to secure healthy people and communities, but is simply a political ploy to gain a win for the administration.

Let’s go down the list of harms.

  • States can opt out of providing the 10 essential health benefits, meaning that primary and preventive care, maternity care, and substance use and mental health treatment can be eliminated from insurance packages both in Medicaid and in the individual market.
  • Premiums will rise for older adults and those with preexisting conditions so steeply that many will be unable to afford coverage.
  • Individuals whose coverage lapses for more than two months will face an insurance surcharge of up to 30%. Worse yet, states will be allowed to waive this requirement in return for allowing insurance companies to use health status (i.e., preexisting conditions) as a rating factor for anyone with a gap in coverage.
  • The federal share of Medicaid will be capped, significantly cutting funding and reducing flexibility for states.
  • The Medicaid expansion will be phased out – affecting 31 states and 14 million people.
  • Planned Parenthood will be defunded for one year, reducing access for hundreds of thousands of people who receive screenings and contraception through their network of health centers.
  • Some employers will no longer be required to provide health insurance.

In the face of these drastic changes, primary care will be hard hit.  Reimbursement rates – particularly for Medicaid — will likely be slashed and the number of uninsured people will rise, forcing the already underfunded safety net to care for more people with fewer resources. People with life-threatening preexisting conditions such as cancer, cystic fibrosis, or mental health issues may face astronomical premiums, forcing them out of the insurance market altogether. Faced with these new realities, primary care providers will be hard hit financially.

We must not let this happen. The AHCA now goes to the Senate where we must make sure that there is a comprehensive national discussion on the key issues of cost, coverage, subsidies, and preexisting conditions. As advocates for primary care, we must raise our collective voices to make sure that this bad bill does not become law.

We urge you to work with PCDC, along with your colleagues, families and friends to send a strong message to the US Senate to reject the AHCA, to build on the successes of the Affordable Care Act, and to ensure that primary care is valued and supported in any health care reform bill.

Louise Cohen, Chief Executive Officer

Phone: 212-437-3917Email: lcohen@pcdc.org Louise Cohen is the Chief Executive Officer of the Primary Care Development Corporation (PCDC), a not-for-profit community development finance institution dedicated to expanding and strengthening the primary care safety net in the United States. PCDC provides capital and technical assistance to a wide variety of primary care providers, and advocates for improved and increased primary care access, capacity, quality, reimbursement, and capital resources in order to improve health outcomes, create healthier communities, increase health equity, and reduce overall health care system costs. Prior to assuming leadership of PCDC, she was Vice President for Public Health Programs at Public Health Solutions in New York City (2011-2015), where she oversaw a variety of programs to improve community health through food access and nutrition, women’s reproductive health, tobacco control, and child development. Ms. Cohen held successive leadership positions at the New York City Department of Health and Mental Hygiene (DOHMH) from 1998-2011, including as Deputy Commissioner of the Division of Health Care Access and Improvement. Among her accomplishments at DOHMH, Ms. Cohen led the development and execution of Take Care New York, New York City’s first comprehensive health policy agenda. She also oversaw the Primary Care Information Project, which brought a public health and prevention-oriented ambulatory care electronic health record system to more than 2,500 primary care providers. Before her tenure at DOHMH, Ms. Cohen was Director of the Park Slope Family Health Center (now part of the NYU Lutheran Family Health Centers network). She served on PCDC’s Board of Directors from 2011 until she became CEO.