hen President Trump tweeted last week about “our wonderful new Healthcare Bill,” it was clear to us what he meant by “our.” The American Health Care Act of 2017 (AHCA) will weaken health care for millions and give tax breaks to the wealthy.
The bill (we’ll call it Trumpcare in keeping with what Republicans called the current Affordable Care Act) will force many older Americans a few years shy of Medicare eligibility to pay substantially more for insurance. While the ACA limits insurers to charging older individuals no more than three times as much for coverage as younger ones, the AHCA will let them charge five times as much. The AHCA’s proposed age-based tax credits, which will replace the ACA’s federal income-based premium subsidies, won’t make up the difference. Only young, healthy individuals who can tolerate bare-bones health care plans could benefit. Older Americans who rely on Medicare and need health care the most will be out of luck.
Children, elders, low-income adults, and people with disabilities who depend on Medicaid also stand to lose. By converting the structure of Medicaid to a per capita cap, the AHCA would slash federal funding for state programs. Faced with the burden of providing care with skeletal support, states would need to restrict eligibility, cut benefits, and increase costs of premiums, deductibles, and copayments.
Trumpcare would defund Planned Parenthood, the largest network provider for women’s health. Each year nearly 5 million women, men, and adolescents rely on Planned Parenthood for screening and treatment of cancer and sexually transmitted infections, as well as for perinatal care.
An ACA mandate currently requires insurers to offer coverage for so-called essential benefits that include emergency, pregnancy, maternity, and newborn care, as well as care for mental illness and substance use disorders. Americans covered by the AHCA could lose some of these essential benefits.
A new report by the Congressional Budget Office estimates that under the AHCA, 24 million Americans would lose coverage over the next decade. That translates to 52,747 extra deaths a year, according to the most definitive study on death rates and Medicaid coverage expansion conducted by researchers at Harvard University and the City University of New York.
There is, however, a silver lining to the AHCA — for the wealthy, that is. It would repeal the current 3.8 percent tax on investment income and the 0.9 percent tax on upper income earners, giving a $600 billion tax cut to the rich over the next 10 years.
This isn’t about some vague notion of “care” or “coverage” that few Americans will lose. If passed, the AHCA will affect millions of Americans, their family members, and their communities. As people forgo primary care or lose access to doctors, many people will miss opportunities to identify curable conditions before it’s too late, and emergency rooms will become more crowded. Hospitals will be forced to increase charges for the insured in order to make up for financial losses elsewhere. The nation as a whole will become sicker and health care will become more expensive.
Passage of this “dumpster fire of a bill,” as Senator Chris Murphy of Connecticut called it, would be a catastrophe. But we can still prevent its passage if we act now. The American Medical Association, American Hospitals Association, American Nurses Association, American Association of Retired Persons, and other organizations have already released statements opposing the AHCA. But statements and lobbying alone may not be enough.
Thousands of health professionals are organizing grassroots efforts to fight this menace. A new generation of politically engaged doctors has been using social media, strengthening professional societies and unions, working with other health care providers, and building a collective voice. The recent nationwide Health Professionals Protest rallied 2,000 participants in white coats and scrubs to protest in front of local representatives’ offices. Many doctors organized the protest; one of us (A.G.) created the Facebook page for them.
With frontline experience and an ethical obligation to our patients, doctors are resoundingly saying, “don’t take away care from our patients.”
But this work is not enough. We need all Americans’ vigilance, dialogue, and protest to keep our government accountable. Together, we must defend health care for those who need it most.
Christy Duan, MD, is a resident physician training in psychiatry at Northwell Health. Andrew Goldstein, MD, is a primary care physician at Bellevue Hospital and a public health researcher at Columbia University. The views expressed by the authors are their own and do not represent the views of the institutions with which they are affiliated.