Dr. Leana Wen: How the Republic House Bill to Replace the ACA Will Harm Millions of Americans

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Yesterday, the House passed legislation to replace the Patient Protection and Affordable Care Act (ACA).

This current bill worsens an already critically-flawed piece of legislation that was introduced in March and failed to pass. The bill will endanger millions of Americans, who will lose coverage for life-saving services. Millions more—including seniors—will no longer be able to pay for healthcare.

The bill contains three key provisions that would result in dramatic consequences to health, in Maryland and across the country.

First, the bill allows states to apply for waivers to remove the requirement that health plans cover essential health benefits. That means insurers are no longer required to cover basic maternity care, forcing pregnant women to pay tens of thousands of dollars out of pocket or forgo prenatal care. Studies have shown that women do not receive prenatal care are five times more likely to have infants who die than women who do have prenatal services.

Insurers can also exclude coverage for emergency services and hospitalization. Victims of car accidents may become bankrupt from hundreds of thousands of dollars of medical debt. Insurers can stop providing coverage for mental health and addiction services. At a time of a public health emergency around opioid overdose, this will cost millions more lives.

Second, the bill removes protection for patients with pre-existing conditions by allowing states to apply for waivers allowing insurers to set much higher rates for those patients. House Republicans have acknowledged the danger of this change and attempted to remedy it by adding additional dollars to create high-risk pools that are supposed to subsidize costs for our sickest patients. However, this addition will not be nearly enough to counter the price increases for millions of Americans who have been diagnosed with a condition such as cancer or diabetes. It also leaves millions with uncertainty that they will lose their health insurance because of chronic illnesses. 

Third, the bill increases the cost of insurance premiums for seniors. The initial bill allowed insurers to charge older adults five times more for health insurance than younger people. Now, insurers can charge even higher amounts and push tens of millions of seniors off their health insurance. These older adults will not be able to afford prescription medication, glasses, hearing aids, and nursing home care.

Passage of this bill will result in devastating consequences for all Americans, and especially children, women, seniors, and anyone with a chronic illness. This is made obvious by the fact that the legislators who drafted this amendment created a loophole to exempt an important group of people from the effect of this bill: members of Congress, their staff, and their families. This exemption crystallizes a core issue in health insurance that the ACA sought to fix: affordable health insurance decreases costs and improves health for all Americans.


Dr. Leana Wen is the Baltimore City Health Commissioner. Follow @DrLeanaWen @BMore_Healthy.

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