Advocacy

Health Reform

health acre reform

The Trump Administration and 115th Congress have made repeal and replacement of the Affordable Care Act a top legislative priority. As they consider major reforms to our nation's health insurance markets and public assistance programs, ASAM and the Coalition to Stop Opioid Overdose are advocating for continued access to coverage for addiction treatment services and the preservation of mental health and substance use disorder parity protections. 

ASAM's Advocacy Team will keep this page up to date with the latest news and information about the repeal-and-replace effort, as well as ASAM's advocacy actions on behalf of its addiction specialist members and the patients they treat.

ASAM Advocacy

ASAM is working independently, in partnership with other medical societies and addiction/mental health advocacy groups, and through the Coalition to Stop Opioid Overdose, to sound the alarm that proposed changes to Medicaid and the private insurance market threaten access to addiction treatment services.

  • ASAM and the Coalition to Stop Opioid Overdose led a letter signed by 455 national, state and local organizations expressing concern with the Senate bill's impact on access to addiction treatment. 
  • Upon public release of the Senate Better Care Reconciliation Act, (BRCA) ASAM issued a statement opposing the bill's cuts to Medicaid and option for states to waive the Essential Health Benefits.
  • The Coalition to Stop Opioid Overdose issued a statement expressing disappointment after House passage of the American Health Care Act.
  • In response to the release of the finalized House bill, ASAM led a group letter signed by 435 organizations voicing concerns about the proposed changes to Medicaid and the Essential Health Benefits.
  • After the introduction of the American Health Care Act (AHCA), ASAM sent a letter to House leadership voicing our serious concerns with the bill.
  • The Coalition to Stop Opioid Overdose sent a letter to Congressional leadership urging that access to addiction treatment services be preserved in any health reform effort, and met individually with key offices to reinforce its message.
  • In January, ASAM, the American Psychiatric Association (APA), American Academy of Addiction Psychiatry (AAAP), and American Osteopathic Academy of Addiction Medicine (AOAAM) sent a joint letter to Hill leadership outlining our shared priorities for any health reform efforts to preserve access to addiction treatment services. 

The Senate Bill: The Better Care Reconciliation Act (BCRA)

The Better Care Reconciliation Act (BCRA) is the Senate Republican Leadership's bill to repeal and replace the Affordable Care Act (ACA), and it's response to the House-passed American Health Care Act (AHCA).

A discussion draft was released on June 22, and an updated version of the BCRA was released on June 26. The most recent section-by-section summary of the BCRA is available here.

Congressional Budget Office (CBO) Report

On June 26, CBO released a report detailing the impact the BCRA would have on health care coverage and costs. You can find the CBO report here.

APA Summary

The American Psychiatric Association released a summary of the BCRA, found here.

The House Bill: The American Health Care Act (AHCA)

H.R. 1628, the American Health Care Act (AHCA), is House Republicans' bill to repeal and replace the Affordable Care Act (ACA).

On May 4, the bill, which was considered pursuant to complex procedural rules known as the budget reconciliation process to avoid the need for 60 votes in the Senate, passed the House by a vote of 217 - 213. The final text for the bill can be found here.

Below, you can find information on important updates made to the bill after introduction and a report released by the Congressional Research Service (CRS) providing an overview of the bill:

 

Congressional Research Service (CRS) Report

The Congressional Research Service issued a 72 page report that provides an overview of the AHCA. The three tables included in the report detail the provisions that apply to the private health insurance market, affect the Medicaid program, and relate to public health and taxes. Each table contains a column identifying whether the AHCA provision repeals an ACA-related provision. The report also includes more detailed summaries of each AHCA provision, and two graphics showing the effective dates of AHCA provisions.

 

Section-by-Section Summaries

Because the bill was considered under reconciliation, both the Ways and Means and Energy and Commerce Committees provided recommendations on changes to the bill:

  • Click here to read a section-by-section of the original Energy and Commerce legislation.
  • Click here to read a section-by-section of the original Ways and Means legislation.
  • Click here to read the American Medical Association's summary of the bill's key provisions.

 

Technical and Policy Updates

On March 20, House Republicans released a series of technical and policy updates.

  • Click here to read a section-by-section summary of the technical changes to the legislation.
  • Click here to read a section-by-section summary of the policy changes to the legislation.

 

Manager's Amendment

On March 24, House leadership and President Trump made many changes to the bill in the form of a manager's amendment to appeal to conservatives in the Republican Conference.

The manager’s amendment:

  • Permitted states to receive Medicaid funds as a block grant,
  • Allowed states the discretion to determine essential health benefits requirements for private plans for the purposes of tax credits,
  • Increased the State Stability Fund by $15 billion for the purposes of covering maternity care, mental health, and substance use disorder treatment.

 

MacArthur Amendment

This amendment, negotiated by Rep. MacArthur (R-NJ), was included in the final version of the AHCA that passed the House. The amendment allows states to waive essential health benefits and community rating requirements if the state has established a high-risk pool.

 

Upton-Long Amendment

Rep Upton (R-MI), former chairman of the House Energy and Commerce Committee, and Rep Long (R-MO) offered an amendment to provide $8 billion to offset the costs of individuals with pre-existing conditions who cannot afford their insurance premiums.

The Congressional Budget Office (CBO) Score

On March 13, the Congressional Budget Office (CBO) released a report providing its estimates of the impact the American Health Care Act (AHCA) would have on federal spending, the health insurance market, and the number of Americans with health care coverage. 

Report Summary, developed by the American Medical Association

Coverage Estimates

  • 14 million fewer people would have health insurance coverage in 2018
  • 24 million fewer people would have health insurance coverage in 2026
    • 52 million people would be uninsured in 2026 compared with 28 million under current law
  • 14 million fewer people will be enrolled in Medicaid in 2026
  • 9 million fewer would be enrolled in the individual market in 2020 than under current law; that number would fall to 2 million fewer than current law by 2026 
  • 2 million people would lose employer coverage compared to current projections for 2020
  • 7 million people would lose employer coverage by 2026

Medicaid

  • $880 billion reduction in Medicaid spending over the 2017-2026 period due to the expansion rollback and lower payments to states through per capita caps
  • CBO noted that “states would need to decide whether to commit more of their own resources to finance the program at current law levels or whether to reduce spending by cutting payments to health care providers and health plans, eliminating optional services, restricting eligibility for enrollment or (to the extent feasible) arriving at more efficient methods for delivering services.”

Subsidies to Low- and Moderate-Income Individuals and Families

  • $637 billion in savings by eliminating ACA subsidies, offset by $361 billion in spending for new tax credits, resulting in $312 billion net reduction in subsidies. Note that new tax credits are only age-adjusted, so the impact of subsidy reduction is heightened for low-income individuals.
  • In general, tax credits for lower-income people would be less under AHCA than current law while they would be higher for upper-income people, especially those with incomes about 400% of the Federal Poverty Level.

Premiums

  • Premiums would rise for the first two years and then decline after that to levels below expected under current law (which may attract more younger people into risk pools).
  • Premiums are also expected to decrease due to the elimination of the actuarial value (AV) equivalent requirement.
  • Older individuals would pay more for premiums.
  • While older people receive a larger tax credit, premiums would be up to five times higher than younger individuals (currently three times). 

Impact on Deficit

  • $337 billion reduction in deficit spending over ten year period.