We often discuss the impact of national policies in terms of macro impact. “It’ll increase GDP” “It will cut the deficit” “It’s good for small businesses.” But, discussing national policies in such broad terms can allow legislators to ignore the detrimental micro impacts – the very real, personal impacts – of the policies they push forward. Such is the case with the proposed replacement for the ACA – the ruinous AHCA. For ruinous it would be for many families and individuals who rely on the subsidies provided under the ACA to cover the cost of health insurance.
Since the AHCA’s rollout, Rep. Barbara Comstock has stayed largely quiet regarding her stance on the bill. She sent a vague email to her distribution list that said nothing beyond, “Here’s the bill.” Her lack of a strong statement on the AHCA is curious given her prior constant calls for repealing and replacing the ACA.
Perhaps she found the sudden off-switch on the frequent calls for repeal and replace because she realizes the catastrophic impact the AHCA would have her constituents. If she is aware of the catastrophic impacts to her constituents, then why isn’t she on the floor of the House fighting for a bill that will help all of her constituents? Why is she not using every tool in her political toolbox to call out this bill for what it is – a thinly veiled redistribution of wealth from those who can least afford it, to those who can more than afford it. Why isn’t she demanding a bill that will help rather than hurt her constituents?
Rep. Comstock should heed these words: this bill will hurt rather than help many of her constituents. It will egregiously injure her impoverished constituents, and her older constituents.
We need to make the shocking consequences of the AHCA’s impact micro for Rep. Comstock. The CBO estimates that 24 million people will lose insurance under the AHCA. Who among her constituents will be part of those 24 million people stripped of life-saving health coverage and left to stand alone in the cold with no one to advocate for their needs? Who among her constituents will be part of the countless others who see their premiums rise to unaffordable levels because of their age, or because of the new 30% surcharge applied to those with pre-existing conditions when they have a lapse in coverage?
Let’s start with her impoverished constituents, many of which are currently covered by Medicaid. The AHCA proposed drastic changes to how Medicaid is funded. Currently, Medicaid costs are split between states and the federal government. For every $1 Virginia spends on Medicaid, the federal government provides $1 in matching funds. Under the AHCA spending on Medicaid would be capped by instead providing a lump sum to each state, no more matching dollar for dollar. Without matching funds from the government, states will likely have no option but to cut Medicaid funding, leaving poverty-stricken families and children – especially children as 54% of Medicaid enrollees in Virginia are children – with no access to health insurance. Virginia is already particularly circumspect when it comes to Medicaid eligibility; any further cuts to the program would decimate those already living in desperate circumstances.
In Loudoun County, 46,943 residents rely on public health insurance, which includes Medicaid. By changing the way in which funding is provided to states for Medicaid, the government will essentially force radical cuts to the program. Many of the 46,943 Loudoun County residents could be impacted by such significant cuts. And there will be no alternative, affordable healthcare option available to them, because the $2,000 – $4,000 tax credit they’ll receive under the AHCA won’t be anywhere near enough to cover the cost of health insurance.
Not only would thousands upon thousands of our fellow Loudoun residents risk losing their vital Medicaid access under the AHCA, but many who need access to the program never had the opportunity because Republicans in the Virginia legislature refused to take advantage of the Medicaid expansion offered under the ACA. 21,178 residents in Loudoun do not have health insurance coverage. Many of those 21,178 residents without health insurance are children. How many could have been covered if our state had taken advantage of the Medicaid expansion?
As for Rep. Comstock’s older constituents, they too will be adversely impacted by the AHCA. Currently, 30,679 of Loudoun County’s residents are over the age of 65. Under the proposed bill, insurers could charge our older residents up to five times as much as they charge younger plan participants – an increase from a current cap of three times. This would generally reduce premiums for younger participants, but drastically increase premiums for older participants – many of whom are living on fixed incomes.
The AHCA would provide an age-based tax credit, so our 30,679 residents who are aged 65 or over would receive $4,000 to help cover the cost of health insurance. But this won’t suffice. Under the ACA, a 30-year old in 2017 is paying, on average $311 monthly for a Bronze plan through the marketplace. Current ACA guidelines limit an insurance company from charging a 60-year old more than $933 for the same plan. And indeed the current average monthly premium for a 60-year old is $743.
But under the AHCA, an insurer could now charge that 60-year old a monthly premium of $1,555, or $18,660 annually. In just three months, our 60-year old will have exhausted their $4,000 credit.
The AHCA will strip thousands of Loudoun residents who form Rep. Comstock’s constituents of affordable and life-saving health insurance. Rep. Comstock owes it to all of her constituents, and especially to those who are most likely to be negatively impacted by the AHCA to unequivocally take a stand on the AHCA. Is she on the side of well-off healthcare executives, and massive insurance conglomerates who stand to greatly benefit from this bill? Or is she on the side of her constituents who need her, as their voice in Congress, to stand up and fight for affordable healthcare coverage for all?
Loudoun Young Democrats Communications Chair