How Americans really feel about the AHCA

More Americans have an unfavorable view of the American Healthcare Act (AHCA) than a favorable one (55% vs. 31%, respectively), according to a new poll.

Here are three key findings that MCOs should be aware of, according to a Kaiser Health Tracking Poll published May 31.

Key finding #1: The survey, performed after House Republicans passed the AHCA on May 4, found that larger shares say the cost of healthcare for them and their family (45%), their ability to get and keep health insurance (34%), and the quality of their own healthcare will worsen if Congress passes the AHCA (34%).

Timothy Hoff, professor of management, Healthcare Systems and Health Policy, D’Amore-McKim School of Business, believes most Americans see the AHCA in a negative way because they heard what the Congressional Budget Office (COB), a non-partisan and expert group that examined the bill, has said-which is that implementing the AHCA as is will cause approximately 23 million Americans to become uninsured over the next decade.

To the extent that the ACHA might reduce health insurance prices in some markets, Hoff thinks it will also bring in a flood of cheap, low-quality health insurance plans without guaranteed benefits in key areas like mental healthcare and maternity care. “Plans would provide little value to many Americans buying them, and also bring high deductibles that Americans will have to pay out of pocket,” he says. “Most people seem to understand this reality, so they logically question what the AHCA really does that will help them down the road.”

Key finding #2: Three-fourths (76%) of the public thinks the healthcare plan recently passed by the House does not fulfill most of the promises President Trump has made about healthcare, while 14% say it fulfills most or all of his promises.

Although proponents of the bill assert that the AHCA would decrease the number of uninsured Americans, CBO’s scoring and analysis revealed that 24 million individuals would likely lose health insurance by 2026. “Other consequences of the bill include a reduction in Medicaid funding, the rollback of the requirement to fully protect against discrimination surrounding pre-existing conditions, and no evidence that the proposed legislation would lower out-of-pocket costs,” says Shawn M. Norris, chartered healthcare consultant and employee benefits consultant, NFP Corp., an insurance broker and consultant.

Under the AHCA, Medicaid funding would be reduced, phasing out expansion and reverting to block grant funding for states. “This would go against President Trump’s campaign intention to save Medicare, Medicaid, and Social Security without cuts-though some may argue that the AHCA doesn’t cut Medicaid funding; it simply halts its expansion,” Norris says.

The AHCA retained the clause to provide coverage to individuals with pre-existing conditions, but it allows insurers to charge higher premiums for those that fail to maintain continuous coverage without a gap for 63-plus days during the 12 months prior to enrollment. “This policy is designed to provide an incentive for continuous coverage and replace the individual mandate; however, it would benefit insurers, as the penalty will be paid to them,” Norris says. Right now, the individual mandate penalty under the Affordable Care Act (ACA) is paid to the government.”

“The inconsistency between rhetoric and the CBO’s analysis that is most overlooked is the pledge to reduce out-of-pocket costs for most Americans,” Norris continues. “Similar to individuals insured under the ACA, enrollees will still struggle to pay deductibles and cost-sharing amounts under the AHCA.”

Key finding #3: Despite the lack of support for the House Republican plan, a majority of the public (74%) say they think it is either “very likely” (37%) or “somewhat likely” (36%) that the president and Congress will repeal and replace the ACA. About one-fourth of the public say it is either “not too likely” (15%) or “not likely at all” (9%).

Repealing the ACA was a core promise of candidate Trump and many GOP congressional campaigns, which is why a majority of Americans may think passage of the ACHA is inevitable. “However, nobody won voters for their compelling plan to replace the ACA, which involves making difficult trade-offs on high-stakes issues likely to alienate potential voters,” says Ryan Marling, research associate, The Clayton Christensen Institute, a nonprofit research organization studying disruptive innovation in healthcare. “The proposed replacement merely shifts the financial burden from one population onto another, and fails to impact the processes and broken business models that perpetuate high costs and poor patient experiences within our healthcare system. The public may have accepted that repeal of the ACA will happen, but for them to reconcile with the AHCA Republicans will need to switch their focus from figuring out how to afford our current healthcare system to how we can change the system to make care more affordable.”

Karen Appold is a medical writer in Lehigh Valley, Pennsylvania.