The AHCA is a bill that was introduced in the US house of representatives in 2017. The bill was a reconciliation bill that would repeal the budget and financial sector of the Affordable Care Act. The Act repealed the penalties initially imposed on a person for the failure to maintain health coverage. The income-based tax credits for insurance purchasing would stop and the federal funding for the states that expanded Medicaid. The Act has its own penalty for individuals who do not adhere to the insurance payments.
The first part of the Act states the patient’s access to public programs. The Act amended the PPACA (Patient Protection and Affordable Act), which provides for investment and improves health care from growing costs. Under the bill, insurers will not be able to deny coverage for treating patients with pre-existing conditions. The bill will also stop federal funding for one year for services such as Planned Parenthood. The bill also enhanced the Medicaid program. The bill amends the Social Security Act to limit the Medicaid eligibility of a person. Other features of the Act include; repealing employer and individual mandates, an individual has to continue their coverage without gaps in payments, or they risk facing a one-year 30% premium surcharge (RAND, 2021). The Act also converts Medicaid funding into a per-capita funding allotment. It replaced the remittance of subsidies to be in that they increased according to age and also changed the ACAs banding from 3:1 to 5:1.
Additionally, the amendment also includes waivers and additional funding for states financially supporting high-risk enrollees. According to an analysis conducted by RAND Corporation (2021), the AHCA, by 2020, would reduce healthcare enrolment by 14 million people. Adversely, the loss of insurance would increase by 20 million in 2026. Older adults would also have to pay higher premiums because AHCA’s tax credits do not age with premiums.
Literature Review
The American Health Care Act of 2017 has been defined by Blumberg et al. (2017) as the Act that would repeal some sections of the Affordable Care Act. The researchers wrote a review paper when congress was considering passing the Act. They write that the Act will bring about changes in the federal taxes because it would eliminate almost all of the ACA’s revenue provisions. The Act would also introduce significant changes in the Medicaid programs (Blumberg et al., 2017). For data collection, the researchers used the Urban-Brookings Tax Policy Centre Microsimulation Model and the Urban Institute Health Policy Centre’s Health Insurance Policy Simulation Model (HIPSM) to allocate changes in taxes and federal health benefits across families grouped by income. The findings were that the American Health Care Act of 2017 had healthcare benefits that were regressive. The study showed that an average low-income family would suffer under AHCA, and an average high-income family would significantly benefit, taking into account both tax deductions and reductions of benefits from ACA. The average low-income family would lose more than 30% of the family income in 2022, and the average high-income family would gain 1.1 % income on their wealth (Blumberg et al., 2017). Families that have above 200% of the federal poverty level (FPL),would experience loss. In comparison, families with FPL above 300% would gain under AHCA, while families exceeding 600% would receive the greatest gains.
Another research conducted about the AHCA was done by Adler, Fiedler & Gronniger (2017). They analyzed the 2011 Medicaid programs and how a per capita would have affected the Medicaid program if it had been initially implemented in 2004 based on 200 spendings. The researchers demonstrate how a per capita like the one AHCA has would have significantly reduced the Medicaid funding in more than half of the total number of states at the same time not providing any funding to any states. They also demonstrated how the tendency of some states to begin a period with relatively lower spending would have generated large and hard to account for spendings. The findings of the study showed that a per capita cap would have reduced spending significantly in Medicaid. Also, under AHCAs per capita cap, a 1% per year increase in Medicaid spending would have nearly doubled the reduction of federal funding (Adler et al., 2017). In contrast, a similar reduction in spending growth would not have diminished federal funding in the same degree.
In another study by Rosenbaum (2017), she conducts a review of Medicaid and AHCA. Medicaid is a big program; the more people it covers, the more extensively poverty is in the US. Medicaid houses and covers children, people with physical challenges and disabilities and the elderly people who need life-time care in nursing homes. Therefore, it implements advanced technology and adopts a program that has always been pursued by lawmakers (Rosenbaum, 2017). Considering per capita basis, Medicaid is effective and efficient as it costs lesser than most forms of insurance cover. It is considered vast because it is always used first hand in dealing with high-risk factors in patients of all ages.
Statistical Analysis
Population Impacted: During enactment, the Act will create employment and economic growth, but in 2018 and 2019, the Act would create federal deficits (Ku, 2017). In the later years, support for healthcare would reduce, causing negative economic effects. By 2026, almost 924 000 jobs would be lost, and businesses would go under loss. More jobs would be in the healthcare sector. The states that adopted Medicaid expansively would experience financial hardships due to a decline in memberships.
The analysis demonstrated how AHCA will cause a massive loss of jobs by 2026, nearly one million jobs. According to Ku (2017) an addition of 23 million Americans will be without health insurance per the CBO. When AHCA became an Act, the Trump administration released a budget proposal. It proposed an additional $610 billion in Medicaid reduction (Ku, 2017). These big cuts would have a huge impact on employment and economic damage as discussed in this study.
Health Outcome: During full implementation, the Act will reduce uninsured Americans by more than half, making more Americans be insured. The Act will also result in health insurance coverage by a total of 94% of the population in America. Uninsured people will reduce by almost 31 million, increasing Medicaid enrolment by 15 million people (Rosenbaum, 2011). This will ensure that health care will be more accessible.
Legislature: The bill was passed to become the American Health Care Act with a vote of 217 in favor of the bill against 213. The House Representatives were voting to repeal the Patient Protection and Affordable Act on May 4, 2017
The Nursing Role
The process of making health legislation in the US is a rather complex process that needs all hands on deck, from policymakers all the way to healthcare providers. When a bill is introduced in Congress, it is passed through various committees before implementing and putting in action. After the bill is voted for, it is passed as an Act and becomes law after it is signed by the president (Mason et al., 2015). Nurses have the ability to influence this process because of their connections to the healthcare organization.
Nurses can first impact the implementation and passing of legislation through their electorate districts as individuals. They can be actively engaged in passing bills to become law. The second way is through nursing bodies and organizations such as the American Nurses Associations, which can work with congress directly (Mason et al., 2015). As members of these professional bodies, nurses can support a bill with other advocates, which boosts their collective power. These efforts are reflected in the passing of a bill.
Also, nurses can play a role in advocating for their patients and hence bring about legislative change by becoming politically active and taking up leadership in the healthcare systems or keeping in contact with political leaders about healthcare system issues. They can also take up formal training classes in the field of politics in order to be able to integrate their nursing and political aspects to be able to be involved in committees, city councils and running for local office positions (American Nurse, 2016). Simply voting will also go a long way in legislating a healthcare policy.
At the healthcare level, the nurses can ensure that the healthcare policies are implemented and followed at the health center. They can educate themselves on the new laws so as to be able to improve patient outcomes and ensure that patients receive the care they deserve and are paying for. It is also important that patients are also informed about the Act and how effectively it can improve their medical care and healthcare.
References
Blumberg, L. J., Buettgens, M., Holahan, J., Mermin, G., & Sammartino, F. (2017). Who Gains and Who Loses Under the American Health Care Act. Washington, DC.
Adler, L., Fiedler, M., & Gronniger, T. (2017). Effects of the Medicaid per capita cap included in the House-passed American Health Care Act. White Paper. Washington, DC: Brookings Institution. About the Center.
Rosenbaum, S. (2017). The American Health Care Act and Medicaid: changing a half-century federal-state partnership. Health Affairs Blog.
Mason, D. J., Gardner, D. B., Outlaw, F. H., & O’Grady, E. T. (Eds.). (2015). Policy & politics in nursing and health care (7th ed.). St. Louis, MO: Elsevier Health Sciences.
American Nurse. (2016, September 22). The nursing profession’s potential impact on policy and politics. https://www.myamericannurse.com/nursing-professions-potential-impact-policy-politics/
Ku, L., Steinmetz, E., Brantley, E., Holla, N., & Bruen, B. (2017, June 14). AHCA economic and employment consequences for states. Commonwealth Fund. https://www.commonwealthfund.org/publications/issue-briefs/2017/jun/american-health-care-act-economic-and-employment-consequences
Rosenbaum, S. (2011, January). The Patient Protection and Affordable Care Act: Implications for public health policy and practice. PubMed Central (PMC). https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3001814/#
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