10 Groups At Risk Under The BCRA

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Writer and tea lover, caught somewhere between Eleven and Diane Nguyen.

At the end of last month, Senate Majority Leader Mitch McConnell (R-KY) abruptly announced the Senate would delay a vote on the Better Care Reconciliation Act–their version of the Republican-led Obamacare repeal plan–until after July 4th recess. Prior to the announcement, the nonpartisan Congressional Budget Office (CBO) announced the proposed legislation would likely leave 22 million Americans without health insurance by 2026, 15 million of whom would lose coverage by next year. They predicted the cuts to key federal programs would only get deeper over time, devastating millions across the country.

When they went home for the summer holiday, GOP senators have laid low, skipping out on parade and barbecue appearances that normally are the main attractions of their mid-summer breaks. But just because health care news has been slow the last 10 days doesn’t mean the bill has gotten any better. Senators are returning from recess this week, which means they’ll push for a vote as soon as possible. With that in mind, here are 10 groups of people who would bear the weight of the Republican health care plan, should it pass the Senate as you consider making a call to your senators to voice your position on the bill.

1. Low- and middle-income people. The BCRA contains a laundry list of ways low- and middle-income Americans will lose should the bill pass. Despite Republicans’ empty promises, the average American’s premiums are likely to increase under the bill, and the Obamacare-era expansion of Medicaid–a federal program designed to help low-income, disabled, and aging Americans pay for health care–would be phased out. And let’s not forget, the bill includes a provision to defund Planned Parenthood in 2018. This wouldn’t necessarily force every Planned Parenthood to close its doors, but it would block federal assistance (like Medicaid) from paying for their services, denying low- and middle-income Americans on Medicaid access to cancer screenings, contraception, and safe abortions.

2. People who might get pregnant. Before Obamacare, 88% of insurance plans did not cover maternity care, but thanks to the essential health benefits requirement, that’s no longer the case. The BCRA, however, allows states to waive essential health benefits requirements for insurers, potentially making maternity costs exponentially higher for people who may get pregnant. Not to mention, stripping Medicaid funds from Planned Parenthood would drastically reduce access to contraception.

3. Women of color. Studies show that women of color are set up to fail under the BCRA. Black women in particular are more susceptible to chronic illnesses, but more were able to gain insurance coverage under the ACA with its guarantee of coverage for pre-existing conditions and Essential Health Benefits. Even still, women of color face massive negative health disparities, but rollbacks of the ACA provisions that helped them get coverage in the first place would undo all the progress made since Obama signed the ACA into law.

4. Older and aging Americans. Phasing out Medicaid expansion has broader implications than simply rolling back income-based eligibility. Many home-care options are subsidized by Medicaid, and if funding is cut, those jobs get cut, too. This could create a shortage of caregivers and limit aging Americans’ options for their long-term care later in life. Even if they do find a home care worker available to care for them, capping a person’s Medicaid benefits could make home care unaffordable entirely, forcing family members to choose between caring for their loved ones themselves, or putting their loved ones in a nursing home against their will. On top of this, Republicans want to raise the premium cap for older Americans to be five times what their younger counterparts pay, compared to the three times under the ACA.

5. Home care workers. As noted above, Medicaid caps could jeopardize home care workers’ jobs by making their services unaffordable to patients. These employees are already underpaid and struggle to unionize as employment models for these workers are often unstable. Should these workers be unable to find work, they too may be ineligible for Medicaid under the BCRA rollbacks, leaving them without a job and without access to health care.

6. Transgender patients. Transgender Americans are still drastically under-insured across the country, but significant progress was made under the ACA. Pre-Obamacare, trans patients were often denied coverage, and even if they could get insurance, transition-related services were often considered “elective,” and individuals would be forced to pay in-full, out-of-pocket. This limited many gender-affirming procedures to affluent, often white, trans folks, and many fear this will be the case again under the BCRA. 

7. People struggling with substance use disorders. Federal Medicaid caps have two major implications for people living with substance use disorders: first, the Obamacare mandate for insurers to cover addiction treatment would be repealed. Second, states would absorb the costs of care that would have been funded by federal Medicaid dollars, forcing them to weigh cuts to other programs. Many fear this will lead to a reduction in substance use disorder treatments on the state level.

8. People living in rural communities. People living in rural communities, especially those who voted overwhelmingly for Trump, often benefit from Medicaid expansion. In fact, a new study shows that of 720 counties where 50% of Medicaid enrollees are children, 617 voted for Trump in November. Beneficiaries of the program’s expansion are overwhelmingly happy with the program, regardless of party. Democratic Senator Claire McCaskill of Missouri witnessed this first-hand at town halls in deep red counties this week. Now, Medicaid-funded programs that benefitted rural communities, especially children, are at risk of being cut under the GOP health care bill. Not to mention, rural hospitals are also at risk of closing as a result of Medicaid cuts, making emergency, preventative, and primary care potentially inaccessible to low- and middle-income residents of rural America.

9. People with disabilities and their families. The senate’s deep cuts to Medicaid would have similar effects on people with disabilities to older Americans. Caps would make it nearly impossible for states to keep up with increased health care costs over time that would come with health technology innovation as well as new treatments and medications. Costs would ultimately shift to individuals and their families, forcing guardians to potentially take less hours at work or leave their jobs entirely to care for their family members full-time. Alternatively, they could pay thousands more per month in out-of-pocket costs for home care or community-based care, which has helped so many people gain independence.

10. People with “pre-existing conditions.” Senators pat themselves on the back for allowing pre-existing conditions to stay on the bill, but they also would allow insurers ridiculous exceptions by eliminating the “Essential Health Benefits” provision of Obamacare. Essentially, insurers would be able to offer you coverage, but with an obscenely high deductible, or certain types of care excluded. For instance, if you’re a survivor of sexual assault and you need to enroll in some type of mental health care, your insurance could offer you mental health care that would cost you thousands of dollars out-of-pocket before they step in to cover the costs, or they could exclude mental health coverage from your plan altogether.

If you fall into any of these categories, or know someone who does, or you plan on getting old someday, this bill affects you. If you want to be involved in the fate of this bill, you can call the Senate Switchboard at (202) 224-3121 to be connected to your senators. Local organizations across the country are also organizing letter-writing and postcard campaigns, phone banks, and demonstrations. Even if you live in a blue state with two Democratic senators, call them. Democrats and Independents are divided on how to proceed beyond general opposition to the BCRA, and your input as a voter could make a difference. You can share your stories on the phone and on social media–make sure you tag your senators–to show them and the rest of the country how you’ll be impacted by the proposed health care overhaul. For many, it’s a matter of life or death.