The 2017 healthcare policy roller coaster ride — and what’s around the bend

Posted December 15th, 2017 by

It’s been a year of wild ups and downs related to the proposed U.S. healthcare policy changes and unknowns around the Affordable Care Act (ACA or “Obamacare”), Medicare and CHIP (an insurance program for kids). See a legislative recap and what could be next.

2017 ACA repeal efforts recap

Having trouble keeping track of what happened this year? You’re not alone. Check out this timeline.

In the spring, we shared the results of a May 2017 PatientsLikeMe healthcare poll, which found that nearly 3,000 participants are largely aligned about components of a strong plan for the country. Right when we announced the poll results in mid-June, the Republican majority in Congress was trying to pass the American Health Care Act (AHCA), which would’ve repealed most of the ACA/“Obamacare.” PatientsLikeMe members shared our poll results – showing the largely united patient voice – along with their personal views in messages to their members of Congress through this Take Action page.

Over the summer, the ACA repeal efforts failed to gain enough support in the Senate, despite a few different attempts (including the Better Care Reconciliation Act, and the so-called “repeal only” and “skinny repeal” bills – see a legislation refresher here).

This fall, Congress turned its attention to tax reform (but has lumped in healthcare changes with less fanfare). In early December, the Senate passed a tax bill called the Tax Cuts and Jobs Act that could repeal the individual mandate of the ACA (the part of the healthcare law requiring that all Americans have health insurance).

The nonpartisan Congressional Budget Office projects that without the mandate, the number of uninsured Americans would jump by 4 million in 2019, on up to 13 million by 2027. Some view the healthcare changes in the tax bill as an attempt at the “skinny repeal” all over again and say that without the mandate, the ACA/Obamacare is at risk of collapse unless Congress takes action to “prop up” the health insurance markets.

Now what? The tax bill is not yet final – now the House and Senate are hashing out differences in their versions of the legislation. Many members of Congress in the Republican majority appear to support the repeal of the individual mandate (one of the least popular parts of the ACA). But most Democrats and several vocal groups like the AARP oppose the tax bill and the possible healthcare fallout.

The estimated $1.5 trillion U.S. deficit increase over the next decade and beyond will “inevitably lead to calls for greater spending cuts, which are likely to include dramatic cuts to Medicare, Medicaid, and other important programs serving older Americans,” AARP says, noting that the tax bill would lead to $136 billion in federal funding cuts in fiscal year 2018, $25 billion of which must come from Medicare. “Such sweeping cuts would be detrimental to an already vulnerable population,” AARP says.

CHIP and VA healthcare programs

Two other pieces in the U.S. healthcare puzzle are also facing risks or changes, but they’ve gotten a lot less news coverage.

The Children’s Health Insurance Program (CHIP) provides low-cost health coverage to kids in families that earn too much money to qualify for Medicaid. In the past, the program had bipartisan support in both the House and Senate, but Congress let federal funding for CHIP expire in September and now states are scrambling to sort out a backup plan for the 9 million children enrolled.

The Kaiser Family Foundation made a map illustrating when states could run out of CHIP funding, with 16 states projected to exhaust their funds by the end of January 2018. They say that children in CHIP may be enrolled in Medicaid, which means states will pay more because the federal match rate for Medicaid is lower than it is for CHIP.

The Veterans Affairs (VA) Choice program could also be in limbo if Congress doesn’t act soon to approve emergency funding to the ailing program, which would expand access to care at non-VA facilities in some cases. VA Secretary David Shulkin is reportedly taking steps toward more privatized healthcare for veterans.

What’s your take on U.S. healthcare policy? Join PatientsLikeMe and discuss your views with nearly 30,000 patients who are interested in advocacy. Also, write to your reps in Congress — patient voices matter.

Editor’s note: On December 20, Congress passed the tax bill, including the repeal of the ACA/“Obamacare” individual mandate. The mandate is still in effect for 2018, so those who don’t have health insurance can still face tax fines. The ACA’s private, individual insurance markets will still be around after the mandate goes away in 2019 but could experience “turmoil” because fewer healthy people will be in the markets, as Fortune reports in their article about what the tax bill’s healthcare changes could mean for you.

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One Comment

  1. Why is it that Medicare will not pay for a senior citizen to be admitted under observation from an ER? Why are hospitals turning away sick seniors who do not meet the life threatening criteria? I went to an ER with a possible kidney obstruction and a UTI, I was given the option to be admitted and be financially responsible for my admission or seek outpatient care. I went into the ER very sick and in pain and left the hospital the same way but in addition, frustrated and exasperated. It just does not seem fair that Medicare has put up these road blocks and by doing so, letting people like myself suffer at home until I can get an outpatient appointment! I am still at home and suffering until I can see a urologist. I was told that the first new patient appointment is in January!

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