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Veterans and the Affordable Care Act: Why the Repeal Would be Devastating

By Jen Tayabji

Right now, many veterans are very concerned, and rightfully so, about the changes that President Trump has been proposing for the Department of Veteran's Affairs, including dismantling the VA health care system with "reforms." Unfortunately, veterans should also be very concerned about the threats to repeal the Affordable Care Act (also known as the ACA or "Obamacare"). We know too well that many veterans do not meet the criteria for full VA coverage, which is connected to discharge status, service-related disabilities, income, and more. In addition, it is not always accessible or meets everyone's needs.

Even though the American Health Care Act (AHCA) — the first repeal plan proposed by Speaker Ryan this session — failed to garner enough votes to make it to the floor at the end of March, Ryan and President Trump, amongst others, continue to discuss repealing the ACA. To understand what this would mean, let's look at just a few of the provisions in the American Health Care Act. The non-partisan Congressional Budget Office (CBO) scored the bill and reported that it would result in 24 million Americans losing their health insurance by 2026. Changes in tax credits from income-based to age-based would have put health insurance out of reach for low-income Americans. Allowing insurance companies to charger older adults even more (5 times as much as a younger adult, compared to 3 times under the ACA) would have put health insurance out of reach for older Americans. Significant funding cuts to Medicaid, combined with changing the program to either a block grant or per capita program, would fundamentally alter the Medicaid program as we know it, affecting all recipients whether they are newborns or residents in long-term care. In last-minute negotiations before the bill was pulled, they were even considering removing protections for those with pre-existing conditions as well as taking away essential health benefits, which sets a minimum of what plans must cover to be considered health insurance.

A recent report by the Urban Institute, released in September 2016, researched the effects of the ACA on veterans. While veterans in general are less likely to be uninsured than the general population, about 11% of veterans under age 65 did not have health insurance before the ACA started in 2014. Because of the ACA, the uninsured rate among veterans under age 65 fell by 42% between 2013 (pre-ACA) and 2015 (one year into the ACA). Their families, including their spouses and children, also gained new health insurance options through the ACA.

Many legislators, including President Trump ran on the platform of immediately repealing the ACA once they were in office. They won't stop trying, despite failing in their first attempt. The ACA has provided millions with affordable insurance coverage. The ACA has also extended protections to nearly all of us, including no lifetime caps, protections for those with pre-existing conditions, a set of standard benefits that must be covered, protections in cost as we get older, and much more. If the ACA were fully repealed with a replacement plan, 32 million Americans will become uninsured by 2026.

In addition to the repeal of the ACA, there are still other threats to how we all access our health care. Congressional leaders have proposed changing Medicaid to a block grant or per capita program. These threats have not gone away since the fall of Ryan's American Health Care Act. This would restrict Medicaid funding either by a set amount per state per year, or by a set amount per person. Basically, the states would have less funding; this means cuts. With the expansion of Medicaid, millions of low-income Americans were able to access insurance. If Medicaid is weakened so that its funding is given out in block grants or per capita grants, fewer people will be able to get coverage, states will have to cut what essential benefits it covers, and worse. Don't forget, Medicaid is the largest payer of long-term care in our country, covering many of our loved ones currently in nursing homes.

Lastly, Congressional leaders, like Speaker Ryan, along with the newly-appointed HHS Secretary Price are eyeing privatizing Medicare or turning it into a voucher program. Most veterans have Medicare (at least Parts A & B) to provide coverage when you need to get care at a non-VA facility. Keep in mind that Vietnam-era vets who don't already have Medicare coverage are aging onto Medicare as we speak. Don't be fooled by Ryan and Price! These plans will wreak havoc for premium costs and throw Medicare into a death spiral. If these plans for Medicare go forward, you most likely couldn't afford to get similar coverage to what you have now under their plan unless you are willing or able to spend a lot more money.

Take action! Find out where your Representative and Senators stand on privatizing the VA, repealing the ACA, cutting Medicaid, and turning Medicare into a voucher program. Make your voices heard. You can reach your Representative and Senators through the Congressional switchboard at (202) 224-3121. Let them know that you're a vet in their district who stands against privatizing the VA, against repealing the ACA, and against cutting Medicare and Medicaid. The efforts to prevent the repeal of the ACA since Congress returned to session in early January is working as they could not successfully pass Ryan's American Health Care Act. Keep up the pressure!

Note: The Urban Institute report can be found at: http://www.urban.org/sites/default/files/publication/84441/2000947-Veterans-and-Their-Family-Members-Gain-Coverage-under-the-ACA-but-Opportunities-for-More-Progress-Remain.pdf.

Jen Tayabji is a Community Organizer with Champaign County Health Care Consumers and on staff with VVAW.