What Nurses Are Saying About The American Health Care Act (AHCA)

By Nurse.org Staff Writer

It wasn’t all that long ago that the healthcare community was in a frenzy about how President Obama’s Affordable Care Act (ACA) would affect how we do our jobs as nurses. 

Would we be flooded with patients with serious illnesses that could have been prevented had they been able to seek medical care sooner? Or would trivial ailments clog up our schedules giving us less time to see the patients that needed us the most? Many of us hoped the greater priority on wellness and prevention would help our patients lead healthier lives.

Depending on which side of the political spectrum you fall, you can surely find anecdotal evidence supporting your argument about the success or failure of Obamacare. On one hand, the ACA seems to have turned out to be anything but affordable. Millions of Americans saw their premiums rise, and at times, astronomically.  However, there were also millions who were finally covered and able to receive the health care they desperately needed.   

Now, we find ourselves on the verge of another huge upheaval of the healthcare system. With Trump in the White House and a Republican majority in both the House and Senate, this overhaul took its first step last Thursday with the House passing the American Health Care Act.

Often referred to as "Obamacare Light", the bill takes on a more gradual transition than the radical ‘repeal and replace’ initially proposed by Trump’s campaign. According to healthmarkets.com, the main points of the new bill are:

• Repeal Obamacare’s individual and employer mandates.
• Decrease and modify premium tax credits by 2020.
• Keep some of Obamacare’s more popular reforms such as protections for enrollees with pre-existing conditions and the requirement that adult children can stay on their parents’ plans until age 26.
• Increase the ratio that insurance companies can charge older enrollees for premiums compared to younger enrollees. This is called “age band rating.”
• Establish a Patient and State Stability Fund.
• Repeal funding for the Prevention and Public Health Fund by the end of 2018.
• Encourage people to use health savings accounts (HSAs).
• Restructure Medicaid funding.
• Repeal many of Obamacare’s taxes.
• Prohibit federal funding for Planned Parenthood clinics, and prevent premium tax credits from being applied to any insurance plans that provide coverage for abortions, with certain exceptions.

No sooner had the House passed the bill that the Senate announced that they would not be voting on the bill. Instead, they will write their own. Sen. Susan Collins of Maine said, “The Senate is starting from scratch. We’re going to draft our bill, and I’m convinced we will take the time to do it right.” 

With weeks of further debate in sight, we were curious to see what nurses thought about the latest developments. Here’s what we found.

What The AHCA Gets Right

Let’s start with the proponents of the new bill. We were shocked to discover how difficult it was to find any statements from nursing organizations or even individual nurses who were in favor of the bill.

Unfortunately, it seems that supporters seem to have been drowned out by the vehement opposition.

However, we were able to determine that support for the American Health Care Act (HR1628) seems to be rooted in its function as a referendum on the Affordable Care Act.

Many healthcare providers agree that there were huge problems with the ACA. One of these is Dr. Marc Siegel, a doctor and op-ed writer for the New York Times. He points out some of his main issues with Obamacare and why it failed:

Obamacare went well beyond these essentials, by mandating an overstuffed prix fixe meal filled with benefits like maternity and mental health coverage that drove smaller insurers with fewer options out of the market. The few that remain often have a monopoly and premiums rise.

He acknowledges the problems associated with the bill, including underfunding high-risk pools and drastic cuts to Medicaid. However, he seems to have full faith that it is a step in the right direction:

The ACA was a one-size-fits-all, top-down approach to policymaking. In contrast, the AHCA moves decision-making to the grassroots by providing funding, but permitting states flexibility in how to deal with costly pre-existing conditions, provide reinsurance and other stop-loss protections that permit insurers to function effectively, and trusting state insurance regulators to run their markets.

Even the significant Medicaid reform needed to ensure the program’s long-term sustainability carries enormous freedom for states to tailor their programs to their populations.

The day after the bill had passed, the Facebook group, Nurses and Doctors for Trump, shared  the following on its page:

 

The article was about the Obamacare taxes which were repealed with the AHCA, stating "$1 Trillion saved! The American Health Care Act (HR 1628) passed in the house reduces taxes the Obama admin had imposed on the American people by over $1 trillion. While giving us real healthcare. Thank You!"

What The Opposition Says

As we mentioned earlier, it was much easier to find nurses and organizations who were opposed to the new bill. Here are a few of the quotes we found. 

The Washington State Nurses Association (WSNA) issued a statement decrying the AHCA the day after it was passed. 

They believe “the bill continues the GOP’s war on women - defunding Planned Parenthood and adding pregnancy, C-sections, sexual assault and domestic violence to its expansive list of pre-existing conditions that insurers use to deny coverage or charge higher premiums.” They also asserted that it would take “money away from low-income and disabled kids to fund a tax cut for the wealthiest Americans.” 

A 14-page thread about the American Health Care Act was started on March 7 on the popular nurse forum, allnurses.com. Since then, there have been over 6k views on the 176 comments.  Here are some of the comments we found there: 

May 4 by  SC_RNDude, BSN, RN

People going to the ER with colds & flu because they don't have a PCP.

As an ER nurse, I can tell you people, in great numbers, who have insurance are still using the ER for such things. Sometimes using an ambulance and getting a Medicare paid taxi home.

I suppose it could get worse, but it truly is hard to imagine it significantly would.

May 4 by MunoRN

...I think there's far more agreement on all sides about what we want in health care reform, but unfortunately, there's more political gain in being divisive. It would make more sense to first define what we want healthcare to do, figure out how much that costs, then figure out how best to pay for it, rather than the current process which is to determine how much we want to pay, then assume that no matter how low that amount is that it will still provide the care we want.

May 5 by Toomuchbaloney

...what I expect is for Senate Republicans to promote a less harmful, less hateful, and less devastating bill which will still hurt poor and sick people while benefiting the wealthiest individuals and corporate entities. It will look almost like a meaningful plan in comparison to Ryan's wet dream.

Be aware that this House Bill does nothing other than to set the stage for their tax giveaway to the wealthy which is next on the agenda.

May 5 by heron

Reading about the "victory celebration" after the vote in the House reminds me of the final scene in Orwell's Animal Farm. The ruling pigs have finally moved into the farmhouse and the rest of the animals find themselves peeking in at them through the window. What they see is the pigs happily feasting while they are starving. As they watch, the pigs gradually transform into the same fat, greedy farmers that they revolted against, to begin with.

Some animals are more equal than others.

I also hear tell that various Democrat campaign funds collected nearly a million dollars in the 24 hours following that vote. Seems like somebody is aiming to misbehave.

May 7 by elkpark

I'm not naive about how politics works and I'm not suggesting that members of Congress and the president and her/his family won't always get the best health care, regardless of what kind of insurance they carry. However, I think it is worth noting that the Democrats ensured in the ACA that members of Congress would have some "skin in the game" and, for what it's worth, be subject to the same requirements they were imposing on the general public, but the GOP, when in the same situation, have at least attempted to specifically, explicitly, exempt and protect themselves and their staff from the arrangements they would impose on the rest of us (I saw reports that House Republicans had been shamed into saying that they planned to remove the amendment that exempted themselves and their staff from their new plan and retained the ACA protections for them, but I haven't seen anything reporting that the amendment is, in fact, absent from the final bill they passed).

May 7 by Lil Nel

Congress is in recess, and I read in Washington Post and NY Daily News about two different Republicans addressing constitutes at Town Halls. One said health care isn't an inalienable right, and the other said nobody in this country dies from a lack of health care.

Both men were drowned out by boos.

How out of touch are these people? Ah, the day of reckoning is coming folks. Republicans are going to need lots of help from their Russian friends if they hope to maintain control of Congress and the WH. 

Health care is going to be sword they fall on. 

May 8 by Elvish DNP, BSN, DNP, RN

I think Republicans' shenanigans - their absurdly out-of-touch statements - in combination with the atrocity that is TrumpCare is making the case for single payer far better than any of us ever could. 

Where Do We Go From Here? 

Clearly, there is much dissent among healthcare workers about the new bill. However, the bill is not without its merits.  Decentralizing healthcare and giving states more freedom to create systems that work for their specific populations could actually help solve some of the current issues with the ACA. With that said, we’re still quite a long way from a final Obamacare replacement. After the Senate writes and passes the new bill, it will return to the House for a vote. 

So while the American Health Care Act still appears to have a long debate-filled road ahead of it, nurses will continue saving lives and caring for the well-being of their patients.  We can only hope that whatever finally comes out of Congress has had at least some input from those on the front lines.

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