The Great American Health Care Debate Moves to the Senate

After a number of closed-door meetings, Senate Majority Leader Mitch McConnell just released a discussion draft of the American Health Care Bill.

There are a number of reasons to be concerned. The bill:

  • Ends Medicaid expansion – albeit a bit more slowly than the House bill – by phasing it out over three years beginning in 2021. When this happens, it is likely that states will not be able to absorb the costs and will cut Medicaid coverage. And in several states including Indiana, “trigger laws” will mean that the state will cut Medicaid expansion as soon as there is a drop in federal funding – so expansion in these states will end in 2021.
  • Caps Medicaid reimbursement with a growth rate to adjust it for inflation. This means that overages occurring because of a health crisis or natural disaster would rest entirely on the state’s shoulders. It also effectively cuts reimbursement by reducing the growth rate cap in 2025.
  • Maintains ACA exchange subsidies, but increases deductibles and eliminates assistance to some middle-income families.
  • Allows states to waive essential health benefit requirements and removes restrictions requiring states applying for waivers to demonstrate that the waived rule will not: result in a drop in individuals covered, reduce the comprehensive nature of the coverage, or impact affordability.
  • Provides nearly identical tax cuts to the House version, largely benefitting wealthy households, insurers, and drug companies.

Why does this debate matter to asset development? There is strong evidence to suggest that health and wealth are inextricably linked in complex and bi-directional ways. In other words, wealth improves health and health impacts wealth. Asset and income poverty makes adults less likely to be able to weather a major health event, especially if they lack insurance coverage. At the same time, untreated chronic conditions can make employment and, subsequently, wealth accumulation more challenging; and this is more likely to happen when individuals are uninsured or underinsured.

Advocates should call their Senators and, at a minimum, ask them to take the time to carefully consider this newly-released discussion draft and any subsequent proposals or amendments. A quick, clear message: “If this is a bill you are proud of, bring it home and discuss it with your constituents over the July recess.” Rushing a vote before the recess does a disservice to the millions of Americans whose health and wealth will be affected by the outcome.