Alaskans should be very concerned with the health care bill the U.S. House of Representatives passed last month. As it is currently written, the American Health Care Act (AHCA) is simply not a suitable replacement for the Affordable Care Act (ACA). You don’t have to be an expert to understand why: One way or another, people have to be able to access affordable care, yet the House bill gives many people virtually nowhere to go.
According to scoring by the Congressional Budget Office (CBO) and the Joint Committee on Taxation (JCT), 14 million fewer people will be covered next year if the AHCA becomes law. Also, 51 million people under age 65 would lack health insurance in 2026 under the AHCA, which is a staggering 23 million more uninsured than under the ACA. Of course, those people could be taken care of in other ways, but the AHCA doesn’t offer many viable choices. Instead, the legislation would slash Medicaid by an estimated $834 billion.
For people who can afford to buy private insurance, premiums will rise drastically — next year alone, they are expected to increase by an average of 20 percent. But those are the lucky ones because the AHCA also provides state waivers that would allow insurers to set premiums based on individual risk, which could make coverage unaffordable for millions of vulnerable Americans with pre-existing conditions.
At the same time, if coverage is not maintained, the hospital payment reductions that were used to fund coverage expansion under the ACA must be restored so that hospitals have adequate resources to take care of patients. They can’t be expected to just absorb the cost of caring for millions of additional patients without coverage.
So, let’s recap if you’re keeping score at home: Under the current AHCA bill, millions of people won’t be covered; many won’t be able to afford their own private insurance; their only other option, Medicaid, will be severely underfunded; and the hospitals that will inevitably end up caring for them won’t receive the necessary funding.
As a nurse practitioner at Mat-Su Regional Medical Center, I am on the front lines, and I can tell you that this approach just won’t work. Costs are rising anyway, and we are facing a doctor shortage, especially in rural areas. The most geographically isolated communities already deal with many challenges accessing care, and Medicaid has been a key to filling coverage gaps. For Alaska, this is truly worrisome because 59 percent of our state’s nonelderly population lives in rural areas.
I’m also concerned with services or benefits that are likely to be excluded from the Essential Health Benefits (EHBs) in some states. For example, maternity care could increase by thousands of dollars in a given year. Considering that more than half of Alaskan births are covered by Medicaid, that could have a devastating impact on many families. Costs for mental health and substance abuse benefits, which are critical considering the opioid epidemic in Alaska and across the nation, could also rise by thousands.
Fortunately, there is an opportunity to get this right. The AHCA legislation is now in the U.S. Senate; with the leadership of our own Senators Lisa Murkowski and Dan Sullivan, we can address many of the shortcomings of the present bill.
The bottom line is that the ACA should not be repealed unless the government can simultaneously enact a replacement that guarantees adequate coverage. Furthermore, we must make sure that those with pre-existing conditions can afford meaningful coverage to access the care they need. We cannot simply restructure Medicaid to make budget cuts to a program that is not even funded appropriately to begin with, and if there are individuals without sufficient coverage, then hospital and health system payment reductions that were used to fund coverage expansion under the ACA must be restored.
• Kris Kile is a nurse practitioner who lives in the Matanuska-Susitna Valley. She is the owner of Surgical Specialists of Alaska.
