Post submitted by Brian McBride, former HRC Digital Strategist 

Republican Senators are working behind closed doors to fulfill a years-long promise to repeal the landmark Affordable Care Act (ACA), which has extended essential, life-saving healthcare coverage to millions of Americans. So it is truly alarming to witness the unprecedented speed and level of secrecy surrounding the GOP’s efforts to remake a system that comprises nearly a sixth of the U.S. economy.

Here’s what’s at stake: 23 million Americans would lose their healthcare by 2026, with 14 million losing coverage as soon as next year if the AHCA becomes law. If Republicans make good on their promise to end the ACA, millions of our nation’s most vulnerable -- including low-income people, children, elderly, women and LGBTQ people -- would lose the coverage they need to survive.

As the debate heats up in the Senate, here are several issues at the center of congressional deliberations.

Medicaid expansion:

The ACA’s success in covering an additional 22 million Americans was due in large part to the law’s expansion of Medicaid. Medicaid was first created to provide health care to low-income families, pregnant women and those with disabilities. The ACA widened the reach of this program by expanding the eligibility to include those making 133 percent of the federal poverty level (FPL). 

For example: This means that a family of 3 making up to $27,000 a year can qualify for healthcare under Medicaid.  In many states without Medicaid expansion adults without a disability or dependent children are not eligible at all regardless of income. In states like Mississippi that have not adopted Medicaid expansion, families with children are only eligible if their household income doesn’t exceed 22 percent of the FPL -- or $4,000 a year for a family of three.

Since it’s creation in 1965, Medicaid has provided millions of Americans, including those who are LGBTQ, with vital access to affordable healthcare, including HIV medication and cancer treatments. Yet, Senate Republicans are discussing how to phase out the crucial program.

Ending Medicaid will not only cause millions to lose access to vital healthcare services, it would also mark the first time ever that the U.S. government rescinded a benefit that is saving millions of lives.

Pre-existing conditions & high risk pools:

Before the ACA was implemented, insurance companies could legally charge higher rates or deny coverage outright to people with pre-existing conditions, including cancer, HIV, asthma, diabetes -- even victims of sexual assault. Today, insurance companies can no longer raise rates or deny coverage for people with these types of conditions.

In May, House Republicans passed their own health care bill -- known as the American Health Care Act (AHCA) -- which would give states waivers allowing insurers to charge people with pre-existing conditions more in the private market. To try to mitigate the severe harm of that change, the AHCA would also create federally-funded high-risk pools for those who are unable to purchase insurance due to pre-existing conditions. Unfortunately, reports show that high-risk pools have failed unless funded at much, much higher levels than in the AHCA, leaving millions across the nation vulnerable running out of coverage.

Historically, people living with HIV have had a difficult time obtaining private health insurance and been particularly vulnerable to insurance industry abuses. Stripping these ACA protections would directly result in tens of thousands of LGBTQ people losing access to life-saving treatment.

Health care exchanges & subsidies:

Another pillar of the ACA are the Health Insurance Marketplace -- or the marketplace “exchanges” -- which is a service available in every state that helps individuals, families, and small businesses shop for and enroll in affordable coverage. The vast majority of enrollees have been able to afford insurance due to subsidies allocated by the federal government. These subsidies are now in the direct crosshairs of Republicans looking to end them.

The subsidies reduce the cost of monthly premiums and out-of-pocket costs. They are, currently based on a person’s income and have been critical for people accessing insurance through their state programs, especially those not enrolled in an employer provided plan or Medicaid. The GOP plan would drastically change the way these subsidies work -- placing them out of reach for so many who have come to rely on them. Republicans want to turn the subsidies into refundable tax credits based mainly on a person’s age.

For example, a person in their 20s would receive a $2,000 tax credit while older enrollees in their 60’s, for example, would get a $4,000 tax credit. Additionally, individuals making less than $30,000 and above $75,000 annually wouldn’t receive any assistance -- greatly affecting lower-income people who are the main recipients of the ACA subsidies.

Annual & lifetime caps:

Before President Obama signed the ACA into law, millions of Americans were enrolled in plans that had annual or lifetime coverage caps. Plans generally limited benefits to  around $1 million. The  AHCA passed by House Republicans -- and what could possibly be in the Senate version -- would once again bring back those lifetime and annual limits.

This provision would have a devastating impact on millions of people, mainly those living with severe or chronic conditions, including HIV and cancer, who typically exceed lifetime and annual limits due to the astronomical cost of receiving treatment.

HRC joined more than 60 organizations to oppose the AHCA and called on Senators to reject this dangerous attempt to undermine the very real gains the LGBTQ community has made under the ACA. Join HRC as we call on Senators to reject this dangerous attempt to undermine healthcare access and preserve the incredible gains the LGBTQ community has made under the Affordable Care Act. All you need to do is text “SAVE ACA” to 30644 and we’ll get you connected.