Impact of AHCA on Health Care Access

Courtesy AP

Despite recent changes to Trump’s health care proposal, a vote was postponed on Thursday, which left the bill with an uncertain future.

President Trump tried to leverage House Republicans, stating that he would agree to no more changes.  He warned – pass the bill on Friday, or lose any chance of repealing the Affordable Care Act.

Meanwhile, the Congressional Budget Office’s analysis on the changes, aimed at securing votes to gain passage, showed that the changes would result in half the government savings but with the same level of un-insurance rates that had previously been projected.

CBO estimates found that the new health care law would reduce deficits by $150 billion over the next decade, but the reduction results in 55 percent less savings compared with the previous draft, where the CBO had an estimated $337 billion reduction.

Effects on Health Insurance Coverage

“CBO and JCT [Joint Committee on Taxation] estimate that, in 2018, 14 million more people would be uninsured under the legislation than under current law. The increase in the number of uninsured people relative to the number under current law would reach 21 million in 2020 and 24 million in 2026.”

Effects on Premiums

“H.R. 1628, with the proposed amendments, would tend to increase average premiums in the nongroup market before 2020 and lower average premiums thereafter, relative to projections under current law. In 2018 and 2019, according to CBO and JCT’s estimates, average premiums for single policyholders in the nongroup market would be 15 percent to 20 percent higher under the legislation than under current law. By 2026, average premiums for single policyholders in the nongroup market would be roughly 10 percent lower than under current law.”

Uncertainty Surrounding the Estimates

“The ways in which federal agencies, states, insurers, employers, individuals, doctors, hospitals, and other affected parties would respond to the changes made by the legislation are all difficult to predict, so the estimates in this report are uncertain. But CBO and JCT have endeavored to develop estimates that are in the middle of the distribution of potential outcomes.”

Comparison With the Previous Estimate

“On March, 13, 2017, CBO and JCT estimated that enacting the reconciliation recommendations of the House Committee on Ways and Means and the House Committee on Energy and Commerce (which were combined into H.R. 1628) would yield a net reduction in federal deficits of $337 billion over the 2017-2026 period. CBO estimates that enacting H.R. 1628, with the proposed amendments, would save $186 billion less over that period. That reduction in savings stems primarily from changes to H.R. 1628 that modify provisions affecting the Internal Revenue Code and the Medicaid program.

“Compared with the previous version of the legislation, H.R. 1628, with the proposed amendments, would have similar effects on health insurance coverage: Estimates differ by no more than half a million people in any category in any year over the next decade. (Some differences may appear larger because of rounding.) For example, the decline in Medicaid coverage after 2020 would be smaller than in the previous estimate, mainly because of states’ responses to the faster growth in the per capita allotments for aged, blind, and disabled enrollees—but other changes in Medicaid would offset some of those effects.”

California Counters with SB 562

In February, Sen. Ricardo Lara (D-Bell Gardens) and Sen. Toni G. Atkins (D-San Diego) introduced the Californians for a Healthy California Act (SB 562).

Senator Lara stated, “Healthy California gives everyone insurance, because everyone has a right to health care. Trump and the Republicans don’t get to pick the health care winners and losers, and we’ll never get to 100% health care in California unless we lead.”

Senator Atkins added, “Access to affordable and quality health care is not only critical, it should be a right for everyone in California. In light of threats to the Affordable Care Act, it’s important that we look at all options to maintain and expand access to health care. The Healthy California Act is an essential part of that conversation.”

Senator Lara has been critical of the Republican proposal to repeal the Affordable Care Act: “Speaker Paul Ryan’s plan to shred the Affordable Care Act is a hard-right wish list that will cover fewer people and cost more, and a huge step backward from our goal of universal healthcare. We need a way to cover the millions of Californians who will lose insurance or pay more under Republicans’ plan, and that’s what the Healthy California Act will do.”

Under the Affordable Care Act and Covered California, the number of uninsured in our state is at a historic low, and we’ve slowed rising health care costs. Last year Governor Brown signed Senator Lara’s Health4All Kids (SB 4), and the 2017-18 budget proposal includes $279.5 million to cover 185,000 children regardless of their immigration status. But lack of insurance still affects immigrant communities, rural California, working families and young people.

President Trump and Republicans in Congress have pledged to repeal the Affordable Care Act. But in six years Republicans had not proposed a plan to replace it. President Trump’s executive order on repealing the Affordable Care Act states that the federal government should “provide greater flexibility to States and cooperate with them in implementing healthcare programs.”

Healthy California Highlights:

  • Every California resident has one plan and more choice. No more plan-switching or guesswork when insurance rates or plans change.
  • You pick your doctor, not health insurers
  • Clinicians make decisions about care, not computers
  • By pooling health care funds in a publicly-run fund we get the bargaining power of the seventh largest economy.
  • We cut out insurance company waste and duplication
  • No more out of control co-pays and high deductibles
  • Public oversight on costs and care, not decisions made in secret
  • Managing prescription drug costs

Californians for a Healthy California Act (SB 562) was introduced on February 17, 2017. Senators Lara and Atkins will be talking about the details in the weeks ahead with the people of California. The bill is sponsored by the California Nurses Association.

“We need to have this conversation now while hundreds of thousands of people are speaking out in support of health care,” said Senator Lara. “With Republicans on the brink of rolling back health care it’s time for California to lead. I look forward to bringing a bill that Californians can support and the governor will sign.”

ACHA Premium Increases

Congressman Garamendi’s office has prepared a chart regarding the substantial premium increases that residents of the counties in California’s 3rd Congressional District would face by 2020 if the American Health Care Act is passed and signed into law in its current form. People 40 years of age or older are expected to see substantial premium increases under the law, while 60-year-olds making $30,000 a year could be facing the prospect of spending nearly half their income on insurance premiums.

—David M. Greenwald reporting

About The Author

David Greenwald is the founder, editor, and executive director of the Davis Vanguard. He founded the Vanguard in 2006. David Greenwald moved to Davis in 1996 to attend Graduate School at UC Davis in Political Science. He lives in South Davis with his wife Cecilia Escamilla Greenwald and three children.

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  1. Tia Will

    Californians for a Healthy California Act (SB 562) gets to the heart of the matter. Currently both Dems and GOP are focused on the wrong issue. Both groups are continuing to place the health insurance industry over its supposed product, health care. The goal should be increasing health, not propping up the profits of the insurance industry. SB 562 is a step towards addressing the underlying issue, access to health care. Since the health insurance industry has continued to need propping up for the entirety of its existence, both pre and post ACA, why exactly do we continue to place its well being over that of its “customers”, our patients ?

  2. Keith O

    How much have premiums for everybody gone up since Obamacare?  I know I’ve seen a steep rise in my costs including premiums, co-pays, deductibles and yearly out of pocket costs.  Obamacare has been a disaster but unfortunately the GOP couldn’t come up with something better, at least so far.

    1. Jim Frame

      How much have premiums for everybody gone up since Obamacare?

      Here’s how premiums for my Kaiser coverage have changed over the last 14 years.  Pre-Obamacare was actually worse than post-Obamacare, and the last two years have been pretty modest increases:

      2003 +12%
      2004 +42%
      2005 +10%
      2006 +11%
      2007 +06%
      2008 +10%
      2009 +24%
      2010 +08%
      2011 +06%
      2012 +10%
      2013 +11%
      2014 +07%
      2015 +05%
      2016 +02%
      2017 +02%

      1. Howard P

        I hadn’t kept those type of records, Jim, but they are much better documentation than I have… and Kaiser is both a insurer, but also a provider… suspect had you had equivalent coverage by BC/BS, the numbers would have been at least the same, if not much more…

        The trend your data shows is contrary (and more honest) than the ‘party line’ spouted in the last 12 months…

        1. Jim Frame

           I notice you don’t show how much your deductibles, co-pays and yearly out of pocket have increased which is all included in the cost.

          That historic information is a lot harder for me to track down, but if those costs have changed they haven’t changed by much — it seems like I’ve been paying about the same co-pays as I always have.  If there’s a deductible I’m not aware of it, and I’ve never hit my out-of-pocket max, which is currently at $2,500.


        2. Keith O

          Under Obamacare my co-pays for a normal doctor visit went from $20 to $30, to see a specialist it went from $20 to $50, emergency room went from $100 to $250.

          My yearly out of pocket max for my wife and I went from $3000 to $6000.

          Non generic drug co-pay went from $25 to $70.

          Generic drug co-pay went up too.

          My monthly premiums have doubled.

        3. Howard P

          Jim… and Keith… a large increase (%-age) in a small # is still a small # ($50 /visit, is not huge to me and I suspect to neither of you).  That might be a big deal to someone making $0 to $30 k/year.  That’s where medicaid/medicare is needed…

          Keith says his premiums have doubled… under Kaiser, mine certainly haven’t… nowhere near… I think it’s too personal to expect Keith to post “doubled from what”?  So, am not asking.

          ACA needs a major tune-up/evaluation, to be sure… the support for the provisions of the formerly proposed AHCA is now obvious… something about a sheet and a corpse.

          The matter needs to be looked at, in my opinion, from the standpoints of providers’ compensation, pharm costs, medical equipment costs, insurance Co. overhead, etc.

          It is not simple.  Perhaps those who wish to make it so are ‘simple’-tons… yet, right now, everyone who could work to change things, seem to be more interested in blaming about the defects, than seeking reasonable solutions, to the two proposals ‘on the table’… we deserve better than that.

      2. Keith O

        I have Kaiser and my premiums have doubled in the last 8 years.  I notice you don’t show how much your deductibles, co-pays and yearly out of pocket have increased which is all included in the cost.

      3. Don Shor

        Other than the 42% (mine was 18% and 20% back to back at about that time period) that’s close to my experience, except for the years when I couldn’t get insurance due to pre-existing conditions. And ACA instantly saved me about $2400 per year on prescription costs.

  3. Howard P

    The ACA has serious problems, to be sure… ACHA has more…

    Insurance is a big part of the problem, but there are others…

    The fact that some parents want heroic measures taken for their infants, when the best possible medical outcome is prolongation of life, with very expensive procedures,  for maybe a year… sometimes more, but still severe impairment… often the conditions are a result of drug/alcohol use by the mother… many of these are “pre-mees”, who only made it to birth by expensive interactions… often, this care is paid by the states or “sucked up” by the medical institution, who then need to make up those costs by higher fees for those covered by employers’, private insurance (who then need to spread those costs to others)…

    The fact that lack of reasonably priced insurance is not available to some (lack of income, and/or pre-existing conditions) , so they go to an ER rather than regular care, cannot pay the ER rates, and again, the institutions have to “suck up” the costs, and pass it on to others.

    Compensation packages for a significant %-age of medical care providers.

    Lack of preventative care/advice by many HC providers.

    Agree with Keith… nothing right now, that would be helpful to level of care, premiums, co-pays, etc., is currently on the table.

    This is a very complex issue… I do not claim to possess a good answer… yet neither ACA, as it currently exists, nor the AHCA, are good answers… the problem is indeed systemic.  And fully enmeshed in partisan politics… this is not good.

    1. Howard P

      PS… was watching on CSPAN… H of  R just went to an indefinite recess… perhaps we should collectively repeal all H of  R elections… a “re-do”… [yeah, that was not real, but sincerely felt, at this moment]

    2. Tia Will


      Your costs have gone up not directly because of the ACA, but rather because of your insurance providers response to the ACA. For the 30 years that I have been in medicine, there has been a gradual rise in the cost of insurance that long predates the enactment of the ACA. If the private health care insurance market had been providing adequately for its “clients” ( AKA patients) there would have been no need for any changes. Obviously this was not true.

      I also want to see the ACA improved. I favor universal single payer coverage as the most effective and efficient way to achieve that goal. If and when we ever achieve this, I also will work for overturn of the ACA.

      1. Howard P

        Tia, respectfully,  you cannot lay the increased costs off only on insurers… Kaiser, for instance, is both an insurance program and a medical provider… their rates went up in mid single digit to low double digits %-ages, each year, over the last 15-20 years [last year was an exception, as it went slightly down]…

        Blaming medical insurers for all of it (and likely, the majority of it) is simply untrue.

        Ask yourself, how much has your total comp gone up in the last 10 years. No need to share, unless you wish to.

        1. Tia Will


          Thanks for the smile. I’ll explain why in a minute.

          First, I want to make clear that I do not believe that it is “all the fault” of the insurance companies. I do believe that they are responsible for their part in the setting of premiums and other costs. And I feel that the insurance companies are a needless and very expensive “middle man” who have much more control over care than many understand or want to believe.

          Now, the reason for the smile. Yes, my compensation has gone up ( I have no idea how much since I do not keep records as Jim does). However, I am sure that you will agree that I have said repeatedly that I do not favor our current model of compensation. I favor a UBI. I see no reason why I should be paid more for my long hours of study, internship, and residency to hone my skills than a field worker who I am sure works equally if not harder, just in a different capacity, or my daughter who works after class hours on designing her lesson plans or working with parents to help a child who is struggling. If you feel that my compensation has contributed to the high cost of medical care, you would be right, but very few dislike this more than I do.

        2. Howard P

          Wasn’t aiming at you, Tia… but there are many physicians who pull in 150% or more of what you do.  And I assume Kaiser covers 100% of medical insurance costs for you and yours (23 years or younger).

          Also assume you have others do your taxes, as you would otherwise keep your tax returns for at least 7 years.  The same 7 years that the ACA has been in place.

          Those returns would show your compensation… and no, am not asking for you to disclose those…


      2. Keith O

        Obamacare caused everyone’s insurance to rise.  The increased costs have skyrocketed in recent years directly because of ACA, there’s no getting around that fact.  Because insurers were forced to cover people with pre-existing conditions to the point where one could get sick or contract a disease and order insurance from their hospital bed everyone is now paying the price.  Who do you think pays for the insurer’s increased costs of taking care of the already sick?  We do.  It’s not just through higher premiums either, the costs are often hidden in higher deductibles, higher co-pays and higher yearly out of pocket increases.  Problem is once some people get an entitlement it’s hard to get rid of as the GOP is now encountering.

  4. Tia Will


    This is a very complex issue… I do not claim to possess a good answer… yet neither ACA, as it currently exists, nor the AHCA, are good answers… the problem is indeed systemic.  And fully enmeshed in partisan politics… this is not good.”

    Appreciate your appreciation of the complexity of the issues involved and agree with your above statement. I also do not claim to possess a good answer, but am aware that many countries have devised systems that are comprehensive and provide statistically better outcomes than ours. I think that a very good start would be to do an in-depth assessment of the systems of these countries and use it as a scaffolding on which to build a system that could be implemented here. I see no need to try to reinvent the wheel from scratch when many are traveling a much smoother path.


    1. Howard P

      And, you also need to look at total comp for physicians /other medical staff in those countries, vis-a- vis the US… and quality of care… broke a hip in France… was treated there… when I came back home, my Kaiser doctors took one look at the x-rays/medical records, shook their heads and said “not good”… about 10 days later, the hip ‘failed’, and needed a re-do by Kaiser… was billed over $40,000 by that wonderful French model… took a payment of ~ $20,000 to get released from the French hospital… ended up ignoring the rest… on advice from French friends…

      [ while I was waiting for surgery in France, my gurney was placed in the hallway. opposite a patient room… saw a man die, despite my calls (in limited French) to get attention when the guy was obviously in respiratory distress… probably close to the ‘longest 10 minutes in my life]

      1. Howard P

        BTW, Kaiser reimbursed me for ~ 98% of my costs, and their “re-do” has been working fine for nearly 3 years now… due to the rod they put in my femur, plus big screws, I “get” to go thru ‘the other’ screening with TSA…

      2. Tia Will


        I am sorry for your bad experience, but I believe it is important to understand that bad outcomes are not necessarily a reflection of the system. I have seen a number of bad outcomes here in the states. I have seen people die in hallways and rooms open to passing patients. I have delivered babies on gurneys and beds in the hallways of hospitals ( not Kaiser) but definitely in the US. These events can happen anywhere.

  5. David Greenwald

    With the withdrawal of the Republican bill – I wonder if this wasn’t the plan all along.  The problem with rescinding the ACA was unless the Republicans wanted to turn tens of millions without health care they had to replace it with something.  I always suspected that would make the ACA far more difficult to repeal than many seemed to believe.  This is a way of having his cake (hey I tried – their fault) and eat it (not turning people onto the streets without coverage).

    1. Keith O

      You got a point, Democrats still own Obamacare.

      The GOP looks bad today but that will fade away and people will be blaming Democrats and Obamacare because they will be paying higher and higher costs along with those that have to pay the ever increasing tax penalties all because once an entitlement is given it’s hard to take away.

      1. Don Shor

        You got a point, Democrats still own Obamacare.

        The GOP looks bad today but that will fade away and people will be blaming Democrats

        Trying to remember now: which party controls the White House, the House, and the Senate?

          1. Don Shor

            Now that they know they can’t repeal the ACA, perhaps some Republican leaders could work with Democrats to pass some modifications that would make the law better for all Americans. There’s no shortage of ideas out there for how to make the ACA more affordable and make health care more accessible.

        1. Keith O

          This is what always gets me, when Democrats want Republicans to work with them when they’ve promised to and have blocked (or tried to) almost every appointee and piece of legislation that Trump and the GOP have tried to put through.

          Remember, the new battlecry of Democrats is “resistance”.

          That hardly sounds like Democrats want to reach across the aisle but they somehow expect Republicans to.

          1. Don Shor

            Um, yeah. So how does that make health care more affordable and accessible for Americans? Especially when tens of millions of Americans would have lost their health coverage if it had passed?
            A dead turkey is still a turkey.

      2. Howard P

        Think you got that wrong Keith… think with both the real problems with ACA and the even more serious problems with AHCA, and both parties doing essentially nothing, and pointing the fingers at each other (and the Republicans also pointing to a segment of their own party), will piss off most voters/citizens with both parties and the congress in general… thinking folk see “failure” all around…

        Ironic, given the tide the president’s boat floated on… that the swamp needed to be drained, Congress/President were too posturing to act, etc.  Next verse, same as the first…

        Republicans control both houses of congress and the presidency… and likely soon (to the extent they can) the Supreme Court… no excuses, based on party lines can be justified…

        1. Jim Frame

          Republicans control both houses of congress and the presidency

          Republicans control all that in name only.  The GOP is deeply fractured (see the AHCA), especially in the House, and Trump isn’t a member of either of the House factions.  The difference now is that they can no longer hide behind the excuse of having Obama in the White House.

    2. Howard P

      Well, if it was ‘the plan all along’, the president, his press secretary, and Ryan ran a great bluff… yet managing to look ineffective and stupid in the process…

  6. Tia Will

    Lets  just hope that this doesn’t turn out to be a zombie turkey.

    I also think it is important to remember that the ACA was based on a Republican plan similar to what Mitt Romney had promoted. Some of its provisions were clearly Republican ideas before the Republicans decided that nullification of the Obama presidency was their primary goal.

  7. Tia Will


    OK… my main point was faulty hip surgery, and a $40,000 bill” I understood that this was your main point. However, you may not be aware that it is entirely possible to have a poor outcome, including a faulty surgery, and still be responsible for the bill unless you happen to have a good attorney in our system. And in our system prior to Obamacare you might have even had an additional whammy, because you now might have had a pre-existing condition, you might not have been able to afford health care insurance at all. Consider that it would have been a negative “hat trick” in the unfortunate circumstance that your faulty surgery left you unemployed and potentially unemployable.

    1. Howard P

      Tia… you may note (or, perhaps not) that I do not refer to the ACA the way you and detractors have chosen to.   You may not have also noted that I have consistently supported elements of it, including pre-existing conditions, etc.  I have an adult child who could not get coverage due to a P-EC (diagnosed when we all thought he was perfectly healthy, and not on our, or an employer’s plan).  Prior to ACA, he had huge premiums from the only provider we could find, huge deductibles, huge co-payments… and he had no income, largely due to his “condition”…

      To say ACA is working perfectly, or even very well, is in my opinion, delusional.  AHCA was not a viable ‘remedy’.

      Going back to pre-ACA will be catastrophic… for very many…

      Yet you seem to deny the flaws in ACA, in the way it is being administered… and seem to defend it in the manner of “My ACA, right or wrong”… perhaps I do not fully understand your nuances…

  8. Keith O

    When people are opening their higher healthcare premium bills this coming November they’re going to blame the Democrats and Obamacare, not the Republicans.  There’s nothing that the GOP has done where they can be held responsible for the higher costs come the end of the year.  I’m sure they will revisit healthcare after the outrage erupts over the failing Obamacare.

    1. Don Shor

      If the problem needs fixing, who’s going to be responsible to fix it?
      If “Obamacare is here to stay” who is responsible for managing the regulations that implement it?
      If the administration is not administering the law properly, who’s going to be responsible for that?
      Who quit advertising for the signups before the enrollment period was up?
      Who reauthorizes the funding for the premium subsidies that people get for their policies?
      Who issues the regulations that the states follow about Medicaid? Who funds the Medicaid expansion?
      If it is here to stay, it has to be administered. They will certainly be answerable for that.

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