The American Health Care Act: Part II -- NASN Advocacy Education Brief

By NASN Profile, RN, BSN, NCSN posted 05-01-2017 09:42


On March 6, 2017, healthcare legislation was introduced in the House of Representatives, ”The American Health Care Act” that would repeal the Affordable Care Act (ACA). Almost immediately, the bill moved to the committees of jurisdiction, which are Ways and Means Committee and Energy and Commerce Committee. This bill as it is currently written would dramatically change Medicaid’s structure through a per capita cap which places a limit on the amount that a beneficiary may receive or a block grant which is a lump sum. In short, a per capita cap means that there is a fixed amount for each child, no matter how sick or disabled that child is, or what is services would be necessary to ensure that child is healthy and ready to learn.

Moreover, the cost-savings from the bill will come solely from reductions in Medicaid. On March 13, 2017, the Congressional Budget Office (CBO) issued a budget estimate of the “cost” of the bill, including any savings from the bill. According to CBO, the GOP bill would cut $880 billion to Medicaid over the next decade by changing the structure of Medicaid, as well as rolling back the expansion of Medicaid in the 25 states that decided to expand Medicaid coverage. CBO states the legislation would reduce the federal deficit by $337 billion.

In the next year, it is estimated that 14 million people would either lose their health insurance because they couldn’t afford it or would chose to not purchase it. Over the next decade, 24 million people would cease to be covered.

However, a majority in the House was unable to garner the necessary 216 votes to pass the original bill through the House of Representatives in March. They had to negotiate with their conservative wing of their party, the “Freedom Caucus” and they have come up with the “MacArthur Amendment.” States would be allowed waivers that could cut the Essential Health Benefits which means that individuals would lose caps on out-of –pocket expenses and would no longer be protected from annual and lifetime coverage limits. This amendment would allow insurers to charge higher premiums for people with pre-existing conditions. This amendment could also rollback the mental health parity.

A vote for the new bill could come the first week of May.

Schools are part of the safety net for children and Medicaid plays a significant role, particularly in the funding of needed medical services for children in special education under IDEA through their IEP, but also for those students without IEPs who are eligible for Medicaid. Medicaid reimbursement to schools for the healthcare of children generates between $4 -5 billion a year or approximately one percent of all Medicaid funds

These changes will impact the ability of students with disabilities and students in poverty to receive many critical health services in schools that enable them to learn. This includes services provided by the school nurse for example vision and hearing screenings and management for students with diabetes and asthma. Additional services affected are mental and behavioral health, speech-language pathology, occupational and physical therapy, and essential equipment for students including wheelchairs and hearing aids. Schools are able to provide these professional services because Medicaid covers the majority of the costs. 

ACTION: Call or Email your Congressman and Tell them You Oppose the American Healthcare Act!

National Association of School Nurses

April 27, 2017