What's really at stake with ACA repeal?


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  • The Senate is currently in the process of repealing and replacing the Affordable Care Act (ACA). The American Health Care Act (AHCA), a proposed replacement, passed the House in May 2017.
  • The ACA provided reforms by expanding the individual marketplace and Medicaid. This helped provide additional options to people with pre-existing conditions, including epilepsy.
  • The AHCA, and related proposals, would lead to higher premiums and/or worse coverage for those with chronic conditions and restructure the Medicaid program in a way that would result in service and eligibility cuts.
  • The Epilepsy Foundation supports polices that provide access to affordable and quality care.
Tuesday, June 20, 2017

UPDATE: September 21, 2017

The Senate is again considering a dangerous health care bill.

On September 13, 2017, Senator Graham introduced a new ACA "repeal and replace" proposal as an amendment to the House-passed American Health Care Act (AHCA), which would threaten health insurance coverage for millions of Americans - including many with epilepsy. This bill, referred to widely as Graham-Cassidy, is similar to other proposals defeated this summer. It would drastically cut the entire Medicaid program, which more than one third of people living with epilepsy rely on for care, and could allow some insurance plans to drop coverage for basic services, including emergency care, prescription medications, and chronic disease treatment.

The Senate is within a few votes of passage on this bill. Write to your senators today and ask them to protect our access to health care using our alert:


Our blog post from June below remains relevant.

Tuesday, June 20, 2017

Health care continues to be in the headlines, and while the debate has been terribly partisan, it is important to remember what is at stake – the availability of quality and comprehensive health care for millions of Americans.

Prior to and even today under the Affordable Care Act (ACA), most Americans receive health care coverage through their employer or an existing government program like Medicaid or Medicare. But the ACA, sometimes referred to as “Obamacare,” targeted a specific population that fell between the cracks – some of the most vulnerable Americans who had no choice but to go without health care for years.

The Current Landscape

Republican members of Congress have been talking about plans to repeal and replace the ACA since it was enacted into law in 2010 by a party-line vote. The first truly significant step in this plan came this May when the House passed the American Health Care Act (AHCA). Now, the Senate has begun their effort of “repealing and replacing” the ACA. Although there has been much reported about the Senate plans – mainly that they will be “starting over” and developing a new plan – beyond that, details have been sparse, to say the least.

For years, Republican members of Congress have been debating changes needed to the ACA and/or complete overhauls of the ACA. There have been many versions of a “plan,” but even now, there has yet to be a single plan they have coalesced around. However, there are some similar threads that run throughout, including:

  • Giving more “flexibly" to the states and reducing regulations on what insurers must include in a plan (which really means insurers will be given the freedom to cover fewer services and fewer people)
  • Repealing the taxes that were included in the ACA to pay for the plan (which really means they need to pay for the plan another way; they choose to use per capita caps on Medicaid, a critical program for the most vulnerable Americans, to find savings)
  • Restructuring/reducing subsidies that help lower-income individuals pay for insurance (which really means fewer low-income and elderly Americans will be able to afford coverage)

While these ideas might not seem destructive on the surface, we can be confident from previous experience about what the results would be – less coverage and care for the most vulnerable Americans, especially disadvantaging those with chronic conditions and disabilities, like epilepsy.

What We Could Lose

To fully understand the current debate, it is important to remind ourselves of why the ACA was enacted and what the status quo was prior to the law’s enactment and implementation.

  • More People Have Health Care under the ACA. The ACA was enacted into law on March 23, 2010. Most of the significant provisions, including the Marketplace, were not implemented until 2014. Even now, it is still a relatively new program and market and undoubtedly has gone through some growing pains. But it has been successful at substantially lowering the uninsured rate and in helping millions get health care.
  • The ACA filled a hole in our health care system. Through reforms to the individual marketplace and through an expansion of the Medicaid program, those who could not get coverage before because of denials or exorbitant costs got coverage for the first time. The individual market prior to the ACA did exist, but plans were often not available to those with high medical needs (pre-existing conditions) either because insurers flat out denied individuals or would only sell them very high priced plans that did not cover even basic services or services related to their pre-existing condition. Prior to ACA, there was certainly a problem – that was not up for debate.

Room for Improvement

At the time of passage, the Epilepsy Foundation was supportive, because the law was the first legislative solution that would help to ensure coverage for a population that did not have adequate options, if any option at all, for health insurance. It was a first step and the Epilepsy Foundation has worked continuously since enactment to see the promises of the ACA fulfilled.

Through our work as a leader of the I Am Essential Coalition, we worked with the administration to encourage them to make improvements to the Marketplace rules and regulations and to ensure that plans offered there supported adequate health care for individuals with chronic conditions like epilepsy.

Losing Access to Quality Care

Without insurance, individuals do not get the care they need and cannot live productive, healthy, or meaningful lives. The Epilepsy Foundation supports access to quality health care that is affordable and comprehensive and that meets the needs of individuals with serious and chronic health conditions. Access to health care is a principal priority for the Foundation.

The plan to repeal and replace the ACA – the AHCA – would do substantial damage to the gains that have been made for particularly vulnerable, struggling Americans and go beyond that by reforming the Medicaid program on which more than a third of people rely.

The AHCA would:

  • Lead insurers to use benefit design to discourage some people from signing up by allowing states to waive some requirements on insurers – like requirements to cover Essential Health Benefits (EHBs)
  • Lead to skyrocketing premiums and cost-sharing requirements for comprehensive, quality plans those with chronic conditions rely on for appropriate care
  • Phase out the Medicaid expansion, which allowed millions to gain coverage
  • Restructure traditional Medicaid in a way that would lead to significant cuts in services and/or coverage eligibility

In the past, insurers had consistently failed to adequately cover the medications and services individuals with epilepsy needed for successful treatment. We have no reason to doubt that a repeal of the EHB requirements would return us to the situation we were in before the ACA.

We know the House passed AHCA is bad. It seems like the Senate knows this too, but now we are left to anxiously await the Senate version. The patient community has sent hundreds of letters to Congress and conducted many meetings with members and staff hoping to influence the Senate process and highlight why the AHCA, as passed by the House, will not work for individuals with chronic conditions and disabilities, including epilepsy. The debate over health care isn’t going anywhere, and we will continue to fight for policies that help ensure access to care for all.

Follow our efforts, get involved, and learn more about health care policy as it relates to the ACA and AHCA at advocacy.epilepsy.com/ACA.

Join the Epilepsy Foundation’s Speak Up, Speak Out list so that you can get involved with our health care advocacy efforts. Every voice matters! Sign up here.

Authored by: Epilepsy Foundation Advocacy Team on 6/2017

Our Mission

The mission of the Epilepsy Foundation is to lead the fight to overcome the challenges of living with epilepsy and to accelerate therapies to stop seizures, find cures, and save lives.

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