The repeal and replace of the Affordable Care Act (ACA) would no doubt have a resounding impact on the campus community. Estimated by the Congressional Budget Office (CBO) to increase the number of uninsured individuals to 22 million, students, faculty, and staff would all be affected by the proposed Senate healthcare bill, the Better Care Reconciliation Act (BCRA) of 2017, released on June 22.
Because the BCRA is moving forward on something of an unusual legislative track, it’s worth taking a look at the current status and expected timeline for the bill. With a Republican majority in the Senate, GOP leadership is taking advantage of a legislative process related to the budget known as reconciliation. Passing BCRA under reconciliation rules allows them to avoid the possibility of a Democratic filibuster to halt progress and allows the passage of this major piece of legislation with only 51 votes. Unfortunately for the Republicans, reconciliation is only done once for each budget process, so in order to use it to pass BCRA, the Senate must move quickly to avoid holding up the FY2018 budget process.
Senate Majority Leader Mitch McConnell was therefore pushing hard to bring the BCRA to vote in the Senate before Congress goes into recess for the 4th of July. Opposition to the bill within the Republican caucus in the Senate, however, led McConnell to delay debate and a vote on the bill until after the July 4 recess. The Senate will reconvene on July 10 and have a three week session to reach a vote before they again to into recess for the month of August. In order for the bill to pass, the Senate will have to secure at least 50 votes (assuming they can rely on a tie-breaking vote from Vice President Mike Pence). Currently there are 52 Republican, and 48 Democrat voices in the Senate, but multiple Republicans have raised concerns upon the release of the CBO report. Democrats are hesitant to take relief in the delay, however, given the unexpected progress of the healthcare bill through the House.
Therefore the next 11 days may prove crucial for the public to weigh in and make their opinions on the BCRA known to their respective Senators. A recent poll conducted by Politico, found only 38 percent of participants in support of the bill, while a similar poll conducted by NPR reported estimates of only 17 percent in support. For more on civic engagement and the legislative process, the NASPActs Policy Basics series by Director of Policy Research and Advocacy, Teri Lyn Hinds, may prove helpful. Your Role in Our Representative Democracy provides tools for civic participation and Political Parties and the Federal Legislative Process may help clarify questions on process through Congress.
Impact on Higher Education
On June 27, NASPA joined 18 other associations in a higher education community letter submitted to Senate leaders by the American Council on Education (ACE) raising concerns about the impact of the BCRA on institutions of higher education and their students, faculty, and staff. The letter includes anticipated impacts of the healthcare bill for the campus community at the individual, institutional, and state levels.
CLASP, a Washington DC based organization that advocates for low-income people, released a June report on threats to higher education by the House version of the bill, the American Health Care Act (AHCA), with a specific focus on cuts to Medicaid. In kind, the majority of the CBO uninsured estimates of the Senate healthcare bill come from a three year proposed phase out of Medicaid expansion. The CLASP report details that in addition to direct loss of healthcare to “low-income and non-traditional students,” states would likely be forced to divert funding from higher education in order to make up for the withdrawal of federal Medicaid funding at the state-level. CLASP points to evidence of this through an analysis of state-level budgeting during the Great Recession. After reaching their spending limits of the General Fund budget, states transferred postsecondary education funding to Medicaid, and many of these budgets have still not recovered. Further reductions in state funding could force public institutions to increase tuition rates, and slash programs to make up for ever-rising costs, placing additional limitations on the pursuit of a quality postsecondary education for marginalized students.
Low-income students may be forced to forego higher education opportunities entirely without the support of Medicaid expansion. 32 states have expanded Medicaid through the ACA, and over 5.6 million students that require coverage, report incomes in line with Medicaid eligibility. CLASP also estimates that flexibility given to the states regarding pre-existing conditions would negatively impact young adults. Many states would allow insurers to discriminate against medical history given this flexibility. In a helpful factsheet, CLASP lays out several health areas of which young adults are especially prone and have received significant support for through the ACA—chronic illness, mental health, and substance abuse—that may risk proper treatment under the Senate healthcare bill. Further, the campus community represents multiple demographics outside of young adults. NASPA recognizes the diversity of the student body and campus community, and the right for all individuals, regardless of medical history to receive quality healthcare.
In addition to state and individual impacts, specific institutions, especially academic medical clinics and teaching hospitals, would be greatly affected by proposed Medicaid cuts and changes to the Medicaid Entitlement Program. If the Senate healthcare bill created a deficit of 22 million uninsured Americans, teaching hospitals would have to cover the costs of this uncompensated care delivered to patients, reducing investment in innovative research and training.
An increase in uncompensated care could come from a number of proposed policy changes to the ACA. First, replacing subsidies with tax credits to support insurance premiums and specific demographics would fail to properly cover the most vulnerable individuals, leading to sicker patients overall. Next, increases in the costs to care would prevent individuals from maintaining regular doctor’s visits and receiving preventable care. This could lead to an uptick in costly emergency room visits, and could devastate the balance of many healthcare systems.
A Bipartisan Solution
Since the announcement of the voting delay, many have started raising potential repercussions if Congress is unable to pass a new healthcare bill. Since the ACA is legally on the books, the law would remain in place, although many worry about its stability. If the ACA stays, it risks premium spikes due to Congressional policy uncertainty since the start of the new administration. North Carolina’s Blue Cross Blue Shield has already warned customers that if the Trump Administration should end cost sharing premiums, premium costs could rise up to 23 percent.
Further, the same NPR poll that reported a 17 percent approval rating of the BCRA also reported only 17 percent in support of leaving the ACA as is. The Center for American Progress (CAP) posits that a responsible repeal and replace of the ACA is possible should a bipartisan solution be considered. CAP has even created a version of the proposed bill, the Market Stability and Premium Reduction Act of 2017, using language from BCRA as a backbone to address the market uncertainty. CAP proposes using effective policy solutions from Alaska and Maine to further carve out cost saving methods to lower premiums without touching Medicaid expansion.
The Association of American Medical Colleges (AAMC) also supports a repeal and replace solution that would “protect and improve the health for all.” On Monday, June 26, the AAMC released a news update on Improving the Health Care System outlining three key aspects to ensure the continuation of high quality healthcare and coverage given a repeal and replace of the ACA. These aspects advocate for: Congress to offer a comparable reform package to the ACA; for Medicaid expansion to remain in place with options to give states more flexibility in implementation; and for Congress to collaborate with health care stakeholders in the process of finding policy solutions.
As an integral part of the campus community, student affairs professionals would be heavily impacted by the BCRA, as outlined in this post. The Policy and Advocacy Team finds the July 4 recess a pivotal period for you to reach out to your respective legislators and express any concerns you may have as well as support for the alternative policies provided.
Was this post helpful? Want us to dig in more on a certain area or topic? Let us know and we may do a post on it in the future!