Following campaign promises to repeal and replace the Affordable Care Act (ACA), President Donald Trump—in conjunction with Speaker of the House Paul Ryan—introduced the American Health Care Act (AHCA) or Trumpcare on March 6. The bill was originally announced as the first of three pieces of legislation which would complete the transition from the ACA and effectively repeal it.
The central goal of the AHCA was to decrease government spending and potentially lower the cost to consumers. The AHCA kept the provision covering pre-existing conditions and allowed the states to continue to enroll persons by means of the ACA Medicaid expansions through January 1, 2020. Enrollments after that date would be disallowed. It would also include tax credits for earners under $75,000 or families under $150,000. People who have a 63-day break in coverage would also incur a 30 percent surcharge, whether healthy or currently suffering from a medical condition. In addition, the AHCA included a provision restricting funds to Planned Parenthood for the next year, but did not include it as a permanent portion of the bill.
The bill drew considerable oppositions from all sides of the political spectrum. The Congressional Budget Office (CBO) found that “healthcare insurance coverage would be reduced by 14 million in 2018, 21 million in 2020, and 24 million in 2026 relative to current law,” according to their analysis published on March 13. In addition, it would reduce government spending by $337 billion over a decade, but only assuming that the Medicaid provision would not be revised in the future. An updated analysis published by the CBO on March 23 pointed out that following several changes in the bill, the government spending reduction would amount to $150 billion instead of the original $337 billion. On the other hand, the tax cuts would amount to $900 billion less in tax revenue collected.
Bishop Frank J. Dewane, Chairman of the USCCB’s Committee on Domestic Justice and Human Development, submitted a letter to Congress representatives outlining the thoughts of the bishops on the proposed bill. While praising some aspects of the new bill, such as the provisions protecting life and the increased flexibility under the new bill, Bishop Dewane highlighted the aspects which he and the USCCB more broadly would be opposed to, specifically centering around the Medicaid position and increased costs for older people with low fixed incomes. He concluded, “The ACA is, by no means, a perfect law. The Catholic Bishops of the United States registered serious objections at the time of its passage. However, in attempting to improve the deficiencies of the ACA, health care policy ought not create other unacceptable problems, particularly for those who struggle on the margins of our society.”
Although Pope Francis has not expressed himself explicitly on the issue, in a meeting with members of the Doctors with Africa last May pointed out, “Health is not a consumer good but a universal right, so access to health services cannot be a privilege.”
On the other hand, the House Freedom Caucus publicly opposed the bill over the fact that it would not do much to decrease spending on the long run. Various right-wing publications have thus termed the AHCA “Obamacare-lite,” criticizing that it does not do away with the problematic propositions of the ACA, while doing little to make the insurance plan market more competitive and prices more affordable.
Following criticism on all sides, Speaker Ryan and President Trump nonetheless pushed for a vote, which was scheduled for Friday, March 24. Within hours of the vote, however, the House bill was withdrawn following multiple sources arguing that Republicans had insufficient support to pass it in the house. Following this move, Ryan and Trump have promised to reintroduced an updated version of the Act in the near future.