The American Health Care Act may have just passed in the house, but it turns out, most Americans are not a fan of the controversial bill. Susana Victoria Perez (@susana_vp) has more. Buzz60


The embattled Affordable Care Act is undoubtedly imperfect, but the newly-passed American Health Care Act should be a serious cause for concern.

Over the last seven years, through a number of challenges, the ACA has had one chief goal. And that was to ensure that all Americans — regardless of job, wealth or health status — were able to gain health insurance coverage. It has accomplished this through (1) an employer mandate that requires many employers to provide insurance; (2) income-based tax subsidies that help individuals purchase coverage; and (3) a significant expansion of Medicaid eligibility. It has outlawed underwriting, which had allowed insurance companies to charge patients with pre-existing conditions more in premiums. As a result of these changes, America has its lowest uninsured rate on record.

But the bill that was passed has a radically different focus: It primarily seeks to limit health insurance costs for healthier, younger and more affluent Americans. By allowing insurance companies to charge older Americans much more than younger Americans, by ditching income-based tax subsidies, by phasing out Medicaid expansion and slashing its funding, and by loosening protections for pre-existing conditions, the new bill puts cost-cutting at the center of its orbit. At the expense of cutting costs for healthier Americans, it cuts coverage for older, sicker and lower-income Americans.  

If implemented, these changes would unquestionably affect Tennessee. Fundamentally altering payments for TennCare, a program that covers 1.5 million Tennesseans and pays for more than half of the births in this state each year, would likely lead to major cuts to the safety net program. Changing the tax subsidy formula would throw the teetering markets into disarray, putting at risk insurance for 230,000 Tennesseans. Loosening protections for pre-existing conditions would make attaining affordable insurance harder for the nearly 1.3 million Tennesseans living with them. And degrading the employer-based rules that both (1) protect employees’ insurance from lifetime caps; and (2) require a baseline of quality coverage would affect the 3 million Tennesseans with employer-based insurance.  

Above all, the newly-passed bill does nothing to address the existential challenges facing the ACA. The answer to what ails the ACA is certainty -- specifically, certainty in enforcing the individual mandate penalty so that insurance companies can adequately spread risk, certainty that cost-sharing payments will be paid to stabilize the markets, and certainty for states in their Medicaid expansion programs. Instead, the AHCA compounds existing uncertainty in the health care delivery system while also removing the protections that the ACA has put in place. It both exacerbates and damages, and the American medical complex is uniformly opposed to it.

In an effort to work on behalf of healthier, younger, more affluent Americans, the bill could result in millions of Americans losing insurance. Those Americans, needing care, will show up to the nation’s emergency rooms, where hospitals are required by federal law to treat them. With uninsured rates rising, hospitals will have to look elsewhere to make up the costs of treating the uninsured. Some may close their doors, especially in states with high rural populations like Tennessee. Others will shift costs to those who can pay. This will eventually push premiums higher even for the healthiest and wealthiest.  

But older people, lower-income individuals and citizens with pre-existing conditions need insurance, too. Over time, we’ve decided to extend coverage to America’s citizens in need. Fifty years ago, America insured its elderly through Medicare and its most financially vulnerable through Medicaid. Two decades ago, it covered millions of children through the Children’s Health Insurance Program. And seven years ago, with the ACA, it provided coverage for almost all others who lacked it, recognizing that insurance is expensive, that employment status shouldn’t determine health status, and that those with pre-existing conditions should have access to care as well.

It is a societal decision that the ACA had made — and one that the AHCA has now unnervingly unsettled.  

Zack Buck is an assistant professor at the University of Tennessee College of Law, where he specializes in health care law and policy.

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