The GOP Released Its Health Care Bill, The American Health Care Act

Vox: The AHCA Will Provide “Much Lower Subsidies,” Roll Back “Much Of The [ACA’s] Insurance Expansion,” And “Cut Medicaid.” Vox’s Sarah Kliff wrote a brief “explainer” on the American Health Care Act, highlighting the major changes the proposed law will have on the health care system. She notes that it “will roll back much of the [Affordable Care Act’s] insurance expansion” by making coverage “less accessible to low- and middle-income Americans.” Kliff outlined potential cuts to Medicaid and explained that “AHCA provides much lower subsidies” than the Affordable Care Act (ACA) does. From the March 7 article:

The American Health Care Act is Republicans’ plan to repeal and replace Obamacare.

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The AHCA gets rid of some popular parts of Obamacare, too. It will roll back much of the health law’s insurance expansion, which currently covers about 20 million people. It does this by making the two big sources of coverage under the law — Medicaid and private individual insurance — less accessible to low- and middle-income Americans.

In private insurance, AHCA provides much lower subsidies for those who buy coverage on the individual market — especially people who are low-income. The Kaiser Family Foundation estimates that, on average, the subsidies in this plan are 36 percent lower than those in current law. This means that it would become harder for people who earn about $20,000 or $30,000 a year to afford coverage if they don’t get it at work.

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AHCA would keep the Medicaid expansion but only until 2020. At that point, states would have to stop enrolling people and anyone who fell off the program — perhaps because their income went up, or they simply forgot to enroll — would not be allowed back on.

AHCA changes the rest of Medicaid, too. Right now, the federal government pays a certain percent of every Medicaid enrollees’ bills no matter how high they go. AHCA would change that: It would have the federal government give states a lump sum for each person in Medicaid, meaning states could run out of money for especially high-cost patients.

We’re still waiting for more analysis on how much this particular provision could cut Medicaid. A lot depends on key details, like how big that lump sum is and how quickly it would grow. [Vox, 3/7/17]

The AHCA Would Negatively Impact North Carolina Residents

CBPP: The AHCA Would “Cut Tax Credits … By More Than Half In North Carolina.” The Center on Budget and Policy Priorities (CBPP) projected that the AHCA would “cut tax credits for current marketplace consumers by more than half in North Carolina.” The CBPP emphasized that the “drastic cuts to financial assistance in high-cost states would almost certainly result in large coverage losses for low- and moderate-income people" and “would greatly reduce the affordability of coverage and almost certainly increase the number of uninsured” in North Carolina. From the March 16 report:

The House plan’s drastic cuts to financial assistance in high-cost states would almost certainly mean large coverage losses for low- and moderate-income people. Enrollment would decline, due both to these cuts and because the legislation would end the ACA’s individual mandate. Those enrollment declines, in turn, also could precipitate further large increases in (pre-tax credit) premiums, resulting in further enrollment declines and further premium increases. In extreme cases, this feedback loop might continue until a state’s individual market shrank drastically, or even completely collapsed — the phenomenon known as an insurance market “death spiral.”

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The average tax credit in high-cost states would fall sharply under the House plan. Enrollees in 11 states would see their tax credits cut by more than half, and people in seven states — Alaska, North Carolina, Oklahoma, Alabama, Nebraska, Wyoming, and West Virginia — would face average credit reductions of more than $4,000. These steep cuts would greatly reduce the affordability of coverage and almost certainly increase the number of uninsured in those states.

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This is a particular risk in Alaska, where the individual market is already fragile and where the House plan would cut average tax credits by 78 percent — not that different from the 2015 bill’s 7 proposal to eliminate premium tax credits altogether. (See box.) The bill would also cut tax credits for current marketplace consumers by more than half in North Carolina, Oklahoma, Alabama, Nebraska, Wyoming, West Virginia, Tennessee, Arizona, South Dakota, and Montana. [Center on Budget and Policy Priorities, 3/16/17]

North Carolina Justice Center: “Under The American Health Care Act, Each Of North Carolina’s Congressional Districts Stands To Lose Coverage Gains Achieved Under The Affordable Care Act.” According to an analysis by the North Carolina Justice Center, under the AHCA, “each of North Carolina’s congressional districts stands to lose coverage gains achieved under the Affordable Care Act.” Brendan Riley, a policy analyst with the Health Advocacy Project at the Justice Center, explained that “of the more than half a million North Carolinians who enrolled in a Marketplace plan this year, over 90 percent” rely on the ACA’s subsidies, which the AHCA would “drastically cut,” pricing North Carolinians out of coverage. Riley added that the impact would be felt particularly by “North Carolinians who disproportionately need more health care services, such as adults over the age of 50.” From the March 20 media release:

Under the American Health Care Act, each of North Carolina’s congressional districts stands to lose coverage gains achieved under the Affordable Care Act, according to new analysis from the NC Justice Center's Health Advocacy Project.

“Of the more than half a million North Carolinians who enrolled in a Marketplace plan this year, over 90 percent of them are relying on the Affordable Care Act’s premium subsidies to afford their plans," said Brendan Riley, policy analyst with the Health Advocacy Project. “The American Health Care Act would drastically cut these subsidies, reducing the help that thousands of North Carolinians in every congressional district currently receive, and pricing them out of coverage.”

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“In particular, the North Carolinians who disproportionately need more health care services, such as adults over the age of 50, would be left behind by the American Health Care Act," Riley said.

Overall, far too many residents will find coverage unaffordable and fewer will remain insured, risking the state's overall progress in reducing the uninsured rate since passage of the ACA. There has been a 50 percent reduction in the uninsured rate in North Carolina's 2nd district alone — progress that will be at risk and could be reversed by the new law. [North Carolina Justice Center, 3/20/17]

Overall, Three Major North Carolina Newspapers Devoted Scant Coverage To The Negative Impacts Of The AHCA

Three Major North Carolina Newspapers Published Only Nine Articles In Total About The AHCA. A Media Matters analysis of three of North Carolina’s largest newspapers -- the Winston-Salem Journal, The News & Observer, and The Charlotte Observer -- found that in the two weeks since the AHCA was introduced in Congress, those three outlets published just nine originally reported articles in total about the bill.

Analysis Of AHCA Coverage In Three Major North Carolina Newspapers Found Major Flaws In Reporting

Newspapers Didn’t Cover The Devastating Consequences Of The AHCA On Women’s Health Care

Papers Ran No Articles Reporting That The AHCA Defunds Planned Parenthood Or Explaining The Consequences For Women’s Health Care. None of the articles Media Matters reviewed in three of the top North Carolina newspapers explained that the law defunds Planned Parenthood and will have negative impacts on women’s health care.

Defunding Planned Parenthood Would Cause “15 Percent” Of People In Low-Income Communities To Lose Access To Care Nationally. Planned Parenthood is an critical provider of essential health care services, particularly in rural and low-income communities. The Congressional Budget Office’s (CBO) analysis of the AHCA found that nationwide 15 percent of people in low-income communities “would lose access to care” as a result of defunding Planned Parenthood. A Guttmacher Institute study found that in 103 U.S. counties (including nine in North Carolina), Planned Parenthood is the only “safety-net health center” with accessible contraception services. The Washington Post reported that defunding Planned Parenthood “would leave many women without services to help them avoid pregnancy, resulting in thousands of additional births.” [Congressional Budget Office, 3/13/17; Guttmacher Institute, 8/14/15; The Washington Post, 3/14/17]

Newspapers Failed To Report That Minority Communities Would Disproportionately Suffer Coverage Losses As A Result Of The AHCA

Top North Carolina Newspapers Had Zero Mentions Of The AHCA’s Impact On Minority Communities. No articles about the AHCA from three of the largest newspapers in North Carolina addressed the impact that the law would have on minority communities.

The AHCA Will Reverse Gains Made By The ACA In Coverage And Will Increase Health Care Costs, Disproportionately Hurting Minority Communities. According to a Families USA fact sheet, “thanks to the ACA, the inequity in uninsured rates for African American and White children was completely eliminated.” However, under the AHCA, “there are 5 million African Americans in insurance plans that they or their families purchase on their own who could lose that coverage or face dramatic increases in their out of pocket costs.” [Families USA, March 2017]

Newspapers Gave Scant Coverage To Skyrocketing Costs For Seniors Under The AHCA

Only Two Articles Addressed The AHCA’s Negative Impact On Seniors. Only two articles included in this study -- one from the Winston-Salem Journal and one from The News & Observer -- addressed the impact the AHCA will have on costs and coverage for the elderly.

The AHCA Will Dramatically Increase Costs And Reduce Coverage For Seniors. The AHCA raises age band ratings, allowing insurers to charge seniors fives times as much as younger individuals. Families USA noted that under the AHCA, premiums for older adults “would be 15-20% higher than under current law.” Vox explained that the CBO report found that a 64-year-old making $26,500 would see “more than a 750 percent increase in premiums” or more than half his or her annual income. [Families USA, 3/14/17; Congressional Budget Office, 3/13/17; Vox 3/13/17]

Newspapers Devoted Minimal Coverage To The AHCA’s Massive Tax Breaks For The Rich

Only Two Articles Addressed The AHCA’s Tax Breaks For The Wealthy. In all the coverage of the AHCA, only two articles -- one from the Winston-Salem Journal and one from The News & Observer -- mentioned that the law cuts many of the taxes on the wealthy instituted by the ACA.

The AHCA Gives $600 Billion In Tax Cuts To The Wealthy. The CBPP noted that the AHCA “would eliminate ACA taxes on wealthy individuals and insurance and drug companies and greatly expand tax-sheltering opportunities for high-income people through health savings accounts.” Vox explained that the AHCA contains “$600 billion in tax cuts - tax cuts that would save the wealthiest 0.1 percent of Americans nearly $200,000 each in a single year.” The Atlantic’s Gene Sperling, former director of the National Economic Council, described the AHCA as “rationing care to fund tax cuts for the U.S.’s highest earners.” [Vox, 3/7/17; Center for Budget and Policy Priorities, 3/8/17; The Atlantic, 3/14/17]

Methodology

Media Matters reviewed the Nexis database for articles published from March 6 to March 21 in the Winston-Salem Journal, The News & Observer, and The Charlotte Observer for any mention of “health care” or “Obamacare” or “Affordable Care Act” or “ACA” or “American Health Care Act” or “AHCA” or “Trumpcare” or “Ryancare.” The analysis did not include wire reports or editorials. Articles that primarily focused on the American Health Care Act were included for analysis. Mentions of the AHCA's potential impact on Medicaid, Medicare, taxes, women’s health care, seniors, minorities, and rural communities were tallied in their own categories.

*Graphics by Sarah Wasko