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The AHCA: Just the facts

Capitolworks LLC is a non-partisan consulting company, dedicated to advancing federal policies that increase the health and well-being of vulnerable populations including children and adolescents. We would like to take today’s Congressional actions as an opportunity to provide educational information on the legislative process and the facts about what today’s events mean for our health care system.

As many of you already know, the U.S. House of Representatives passed the American Health Care Act (AHCA) earlier today by a vote of 217 to 213. Today was the first time the bill was brought to the floor for a vote. Now that it has passed the House, what can we expect to happen next?

First, the AHCA is not law. It has been passed by only one chamber of Congress, and for a bill to become law, the same legislative language must be passed by both chambers (House and Senate) and signed by the President. Having passed the House, the AHCA will now move to the Senate for their consideration. Our colleagues in the Senate inform us that this is not a popular bill among Senate Members and that efforts are already underway to rewrite various sections of the bill.

We anticipate the entire process taking several weeks as there are Congressional recesses and other activities that must be addressed by Congress during this same timeframe.

If the Senate can pass a bill, the two chambers will either proceed to a conference during which they will negotiate the differences in the bills or, the House could elect to vote on the Senate bill, skipping the conference process. Upon passage by both chambers, the bill will then go to the President for signature although he reserves the right to veto.

As for what is in the bill, there are many websites to turn to for information on the various changes that this bill would create for different populations, various health care providers as well as the state governments. As our focus at Capitolworks LLC is vulnerable children and adolescents who are often left out of the legislative process, our priority has been and will continue to be, the changes proposed to the Medicaid program. A quick note on Medicaid.

Medicaid is an open-ended entitlement program, which means, if you qualify under a variety of circumstances, you receive Medicaid coverage. It is a program with shared responsibility between the states and the federal government and has been in existence for decades. For children, it is important to remember that this is not just an income eligibility program. Meaning, not just low-income children receive health care insurance coverage under Medicaid.

Children and youth who are abused and neglected and part of the child welfare system are covered by Medicaid. Children with special health care needs receive coverage as well. An example of this population is a child born with a disability, a child that has a developmental disability such as Autism or a child who was otherwise healthy but sustained an injury through sports (a brain injury) or an accident who now has significant impairments perhaps both physically and mentally.

Additionally, children and youth enrolled in special education within their school receive services that are reimbursable through the Medicaid program. These are just little-known examples of other populations who benefit from Medicaid.

The AHCA has proposed implementing a per capita cap structure which essentially gives states a per person rate based on previous years expenditures. It is a rather complicated equation of risk adjustments and other factors that we will not go into in this post. It is a structure perceived to curb up front costs in the Medicaid program. How much that savings will be is not known as the costs themselves will shift to other systems of care, such as the child welfare system, the justice system, emergency room utilization, etc. and those costs are difficult to predict.

Everywhere you look today, and in the coming days, you will hear not just opinions on the current House bill but speculation as to what the Senate may or may not do, how these bills will impact various sub-populations both positively and negatively, etc. We hope to serve as a resource that looks at the facts before us and to offer information so that everyone can feel knowledgeable and educated on what is truly taking place versus what partisan politics will try to make us all believe.

We urge you to share this post with others, and of course, we are happy to entertain any questions or concerns.

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