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On May 4, 2017, the House of Representatives narrowly passed H.R. 1628, the American Health Care Act (AHCA) - on a partisan vote of 217-213 - with zero Democrats voting in favor.  NASW expressed strong opposition to this bill, as AHCA would bring substantial changes to the health care system and gravely impact low-income and vulnerable communities.


On May 24, 2017, the Congressional Budget Office (CBO) released its score of the AHCA. The CBO found that an additional 23 million individuals will be uninsured by 2026 if the legislation is signed into law.


AHCA is now before the Senate who must decide whether or not to accept the House version as written or to create their own version. Senate Majority Leader Mitch McConnell convened a working group of thirteen Republican Senators to draft a Senate version of AHCA. The new iteration of the ACHA that emerges from the Senate working group will reflect the values and priorities of its authors.


Given that the working group does not include any senate Democrats, or minority Senators, the revised bill is unlikely to address critical provisions such as protection of Essential Health Benefits for insured Americans. Nor should we assume that the new AHCA will ensure access to quality health care for the nation's uninsured and under-insured. Therefore, NASW has an obligation to closely monitor the proposed changes to AHCA made by the Senate.


NASW believes that any health care reform legislation needs to successfully build on the benefits and comprehensive health care coverage of the Patient Protection and Affordable Care Act (ACA).  With that in mind, below are NASW's expressed principles that are essential in the Senate's final version of AHCA:


Affordable Insurance Coverage

The ACA brought affordable health insurance to many individuals and communities through cost sharing subsidies and Medicaid. Cost should not be a barrier to obtaining health coverage-and low and middle-income individuals and families are especially in need of financial relief from the high cost of health insurance.Premium subsidies make health insurance affordable for low and moderate-income individuals and families must be a major feature of the Senate's health care bill.


Medicaid Expansion

To cover more Americans, ACA included expansion of Medicaid eligibility and access to health care. This meant that millions of previously uninsured individuals and families could now receive quality comprehensive care. Expansion of Medicaid eligibility must be continued. Without it, as many as 15 million men, women, and children will become uninsured.


Maintain Medicaid Budget at FY 2017 Levels

The House version of AHCA requires that Medicaid be cut by $880 billion over a ten year period. That is an unacceptable reduction in funding and will leave many millions of Americans without health coverage. Therefore, it is imperative that the Senate rejects any cuts to Medicaid below the FY 2017 spending level.In addition, NASW believes the current model for allocating Medicaid funds to the states should not be changed. For example, NASW is opposed to funding formulas such as capped funding or block granting Medicaid to the states. Such a change would strain resources at the state level, resulting in far fewer needy individuals and families eligible for Medicaid, and a significant reduction of crucial health care services.


Enhance Access to a Range of Services

A health care system must take into consideration the comprehensive needs of patients and provide coverage for a full range of health services including mental health and substance use disorder treatment, women's health services, and preventive services.Investment in appropriate health services today can save the system money and prevent chronic and serious illness in the long-run.Health care proposals should require health insurance companies to continue coverage for services outlined in the Essential Health Benefits established by the ACA.




Protect Coverage for Pre-existing Conditions, Promote Comprehensive Essential Health Benefits, and Prioritize Needs of Vulnerable Populations

The AHCA passed by the House cuts nearly a trillion dollars from Medicaid to cover tax breaks for wealthy Americans.At the same time, the bill would allow states to deny insurance coverage for individuals with pre-existing medical conditions, and charge older Americans significantly higher premium rates than younger people. The Senate must restore the mandate that insurance providers cover pre-existing conditions. It also must eliminate disparities in premium costs for older Americans, which many of whom cannot afford.


Above all, the final version of AHCA, as revised by the Senate, must enhance the wellbeing of our most vulnerable individuals and families so that they can be active participants and contributors to society. This is both cost-effective in the long-term and the right thing to do.


Make Your Voices Heard

As the Senate Health Care Working Group continues to craft its version of the AHCA, it is vital that NASW members reach out to your Senators and ask them to fight for NASW's principles in any health care reform proposal taken up in Congress.Tell them in your own words how vital it is that Congress preserve protections for pre-existing conditions, promote comprehensive essential benefits-including mental health and substance abuse treatment, women's health services, and preventive services and prioritize the needs of vulnerable populations.This is the only path forward and social workers are counting on their Senators to do the right thing.


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