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House leadership releases changes to AHCA


House Republican leadership released changes to the American Health Care Act (AHCA) in hopes to garner more support for the bill before Thursday’s vote.

The changes come after many Republicans in the House and Senate have been vocal in their criticism of the bill. Conservatives believe the bill doesn’t go far enough to undo Medicaid expansion and other mandates created by the Affordable Care Act (ACA). More moderate Republicans are concerned by the CBO’s report that 24 million more people would be uninsured compared to ACA.

Though some provisions in the modified AHCA bill improve the base bill, NRHA is concerned that the bill still falls woefully short in making health care affordable and accessible to rural Americans. For example, the modified bill contains a decrease in the Medical Expense Deduction threshold from 10% to 5.8% in an attempt to assist Americans between the ages of 50 and 64 who would see their premiums skyrocket under the current plan. However, this deduction is not a credit and therefore would be of little use to low income seniors that are in very low tax brackets or do not pay income tax at all. Additionally, the new amendments to freeze Medicaid expansion enrollment as of Jan. 1, 2018, and reduce the Medicaid per-capita growth rate will disproportionately harm rural Americans.

Let’s be clear -- many provisions in the ACA failed rural America. The lack of plan competition in rural markets, exorbitant premiums, deductibles and co-pays, the co-op collapses, lack of Medicaid expansion, and devastating Medicare cuts to rural providers -- all collided to create a health care crisis in rural America.  However, it’s beyond frustrating that an opportunity to fix the problem is instead destined to create a greater health care crisis in rural America.

The AHCA will cause more harm to rural Americans, leaving millions of the sickest, most underserved populations in our nation without coverage, and further escalating the rural hospital closure crisis. According to the Wall Street Journal, the “GOP health plan would hit rural areas hard… Poor, older Americans would see largest increase in insurance-coverage costs.”  The LA Times reports “Americans who swept President Trump to victory — lower-income, older voters in conservative, rural parts of the country — stand to lose the most in federal healthcare aid under a Republican plan to repeal and replace the Affordable Care Act.” 

Congress has long recognized the importance of the rural health care safety net and has steadfastly worked to protect it.  Much of the protections created to maintain access to care for the 62 million who live in rural America is now in jeopardy.  We implore Congress to continue its fight to protect rural patients’ access to care.

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