CBO Estimates ACA Repeal and Replacement Bill Will Devastate Black Women’s Health

Published Wednesday, March 15, 2017 10:00 am

For Immediate Release:


CBO Estimates ACA Repeal and Replacement Bill Will Devastate Black Women’s Health

Head of Black Women’s Health Imperative analyzes impact of AHCA on Black women’s health and calls on policymakers to protect Black women’s access to affordable health care


WASHINGTON, DC (March 15, 2017)  The nonpartisan policy experts with the Congressional Budget Office (CBO) and the Joint Committee on Taxation (JCT) recently released an estimate of the implications of the American Health Care Act (AHCA), the bill that could repeal and replace the Affordable Care Act (ACA).  Despite not having this necessary estimate, the House of Representatives’ Leadership decided to move forward with the legislation by having two committees—Energy and Commerce and Ways and Means—markup and vote the bill out of the committees.

According to the CBO and JCT, while the AHCA will save the federal government $337 billion over the next decade, it comes at the expense of an astounding 52 million people being uninsured by 2026 compared to 28 million if the ACA remained in effect as law.  Specifically, the enactment of the AHCA would lead to 14 million more people becoming uninsured by 2018, 21 million more in 2020, and then an additional 24 million in 2026.  Moreover, the White House’s internal analysis, confirming the devastating impact of the AHCA on the American people, looked even worse than the CBO and JCT estimate by suggesting that 26 million people would lose their insurance within the next decade.  The losses would include 17 million from Medicaid, 6 million from the individual market, and 3 million from employer-based plans.  The internal analysis also revealed that a total of 54 million people would be uninsured in 2026 under the AHCA.  

Over the past 6 years, we have an experienced an historic decline in the uninsured rate among Americans, especially Black Americans.  Between October 2013 and early 2016, approximately 3 million Black Americans gained coverage causing the uninsured rate for Blacks to drop by more than 50 percent.  Specifically, the uninsured rate for Black women dropped by more than 40 percent over the past five years.  However, the AHCA has the ability to reverse the progress that we have experienced over the years.  

There are several provisions within the AHCA that are cause for concern.  If the AHCA is enacted, premiums will rise as a result of the elimination of the ACA’s individual mandate, which requires the purchase of health coverage.  Specifically, the CBO and JCT estimate suggests premiums will be five times higher for seniors under the AHCA versus three times higher under the ACA.  However, this bill does not take into account premium increases but rather eliminates the income-based tax credits that have allowed millions of low- to middle-income Black women to afford the cost-sharing requirements (e.g., monthly premiums, copays, and deductibles) of their selected health insurance plans.  Instead, the bill institutes a flat age-based tax credit, which increases cost-sharing assistance as individuals age.  But, according to the CBO and JCT estimate, fewer low-income people will obtain coverage under the AHCA marketplace due to the smaller premium tax credit they will receive compared to the amount they currently receive under the ACA.  On the other hand, individuals with higher incomes would receive much larger premium tax credits under the AHCA as compared to the ACA.  In 2020, the CBO and JCT estimate the average tax credits would be 60 percent of the average subsidies under the ACA.  And by 2026, the average tax credit under the AHCA would be just 50 percent of the average subsidy under the ACA.  This provision, which removes income from consideration, puts affordable health coverage out of the reach for most Black women, young adults and seniors. Moreover, the AHCA imposes a penalty for individuals who experience a lapse in coverage that stretches beyond two months (specifically, 63 consecutive days or more).  These provisions will particularly impact Black women since Blacks tend to make up a larger portion of individuals who are low-income—23 percent live in poverty, Black women make much less than White men—65 cents for every dollar earned by White men, Black women are more likely to be the sole provider for the family, and Black millennials have a significantly lower health insurance enrollment rate compared to their White counterparts.

Unfortunately, this bill provides many benefits to the wealthy when there should be more incentives for lower-income individuals.  For example, the AHCA gives tax breaks to individuals who create and use a Health Savings Account (HSA), however, in order to fully benefit from an HSA, an individual must have a salary high enough to be able to set aside funds strictly for medical services and bills, which is not feasible for the low-income and those living paycheck to paycheck. The benefits do not outweigh the risks of losing monthly income to a savings account when coverage is already expected to rise to such a level that there would not even be enough money to afford monthly premiums.

According to the CBO and JCT estimate, 14 million people will lose coverage as a result of the AHCA’s elimination of Medicaid expansion and restructuring of the traditional Medicaid program. Over 11 million individuals in the "Medicaid Coverage Gap" – where an individual made too much money to enroll in traditional Medicaid but did not make enough to qualify for ACA subsidies – gained health care coverage through the expansion of Medicaid in 32 states, including the District of Columbia.  The expansion helped to bring affordable health care to millions of individuals and resulted in the detection of previously undiagnosed health conditions that needed immediate treatment.  By rolling back Medicaid expansion, the AHCA removes access to life-saving preventative services and treatment for our most vulnerable citizens.  Moreover, the AHCA does not identify a pathway for poor individuals in the Medicaid Coverage Gap who currently live in non-expansion states.  This fact is particularly important for Black people because approximately 55 percent of Blacks live in states that have not expanded Medicaid, which further exacerbates health conditions and widens current racial health disparities.

In addition to eliminating Medicaid expansion, the AHCA also changes the financing structure of the traditional state Medicaid program.  Under the AHCA, Medicaid funds will be capped based on a pre-determined formula, which does not take into account several factors such as the actual cost of medical services for each Medicaid beneficiary.  This restructuring could shift $370 billion to the states.  Instituting a per capita cap system will allow states to restrict access to necessary preventative and life-saving medical services as a result of drastically reduced federal funding.  In 2015, Blacks accounted for 19 percent of Medicaid beneficiaries nationally. However, in some states, specifically southern states (Louisiana, Georgia, Mississippi, and District of Columbia), Blacks accounted for more than half of all Medicaid beneficiaries.  This means that millions of Black Medicaid beneficiaries will potentially face a reduction in Medicaid service, removal from the Medicaid program, or the imposition of onerous requirements such as work or cost-sharing requirements.  

The AHCA will restrict access to the desired provider of health services for millions of low- to middle-income Black women—Planned Parenthood simply because it provides access to a constitutionally-protected right for these women—abortion services.  The AHCA would prohibit federal Medicaid funding for Planned Parenthood clinics for a period of one year.  In addition to providing family planning and reproductive health care services, Planned Parenthood provides preventative and primary health services and is oftentimes, the only provider of these services for those who live in rural and medically underserved areas.  According to the CBO and JCT estimate, 15 percent of these people will lose access to care as a result of the AHCA.  In addition, the estimate suggests that while the authors of this legislation intended to decrease federal spending, defunding Planned Parenthood would result in an increase in Medicaid spending due to the several thousand additional births that would result when women’s access to this provider loses federal funding.  In addition, some of the children of these women would likely qualify for Medicaid or other federal programs.

Moreover, the AHCA includes other provisions that will also remove access to abortion services for millions of low-to middle-income Black women.  In addition to defunding Planned Parenthood, the AHCA will redefine the term "qualified health plans" to exclude plans that cover abortion services and prohibit the use of tax credits to purchase any plans that cover abortion services.  Black women have traditionally faced barriers to accessing abortion services due to the Hyde Amendment, which prevents the use of federal funds to cover abortion services, but the AHCA goes many steps further by erecting additional barriers to accessing abortion services.  

While prevention is a key element to improving the health of communities and lowering medical debt, the AHCA eliminates the Prevention and Public Health Fund by next October.  This fund was created by the ACA and makes up approximately 12 percent of the Center for Disease Control and Prevention’s annual budget.  States have been reliant on the fund to support public health and preventative efforts such as breast and cervical cancer screenings, and obesity and diabetes reduction programs.  In addition, this fund was instrumental in sending aid for the Zika outbreak and Flint water crisis, which disproportionately impacted women and children of color.  The swift elimination of this fund will remove programs that have been successful in reducing preventable deaths in communities of color, that have been burdened by higher rates of chronic and preventable diseases such as diabetes and breast and cervical cancers.

“Congress must ensure that all people, including those who have traditionally faced systemic barriers to accessing health care, have the ability to access affordable, comprehensive care," said Linda Goler Blount, President and CEO of the Black Women’s Health Imperative.  “Health care should not be a right only exercised by the wealthy.  When Black women are healthy, they can work, go to school, feed their families, and become significant contributors to the economy.  Removing their ability to remain healthy will not only impact their families, it will impact their communities and this country.  I urge Congress to evaluate the potential ramifications of its actions before taking any definitive steps to repeal and replace the ACA.  While the American Health Care Act seeks to put patients first, the only way this can be done is by listening to the voices and concerns of patients—their constituents—before taking any drastic steps to remove key health care protections they have or change the current health care system.  If not, these changes could devastate the health of Black women and their families."

It is clear that AHCA is not in the best interest of the American people, especially low- to middle- income Black women.  Unfortunately, the current CBO and JCT estimate only provides an initial overview of the implications of the AHCA.  With more information and more time, the CBO and JCT would be able to provide a full analysis of the true implication of this piece of legislation.  However, with the current CBO and JCT estimate, we know that the proposed repeal and replacement legislation will result in an increase in preventable diseases, avoidable deaths, and economic instability that will weaken Black communities across the country.  We continue to urge Congress to fully engage in robust conversations with constituents, policy experts like the CBO and JCT, and other stakeholders through full committee congressional hearings, district town halls, and listening sessions before moving forward with the repeal of the ACA and replacement with the American Health Care Act.  By doing so, Congress will be able to fully understand the impact of the proposed health care "repeal and replace" on the lives of the American people, especially Black women and their families.  We ask Congress to ask themselves:  is it more important to save federal dollars or save the lives of all Americans?



About the Black Women’s Health Imperative
The Black Women’s Health Imperative is the only national organization dedicated to improving the health and wellness of the nation’s 21 million Black women and girls — physically, emotionally and financially. We identify the most pressing health issues and invest in the best of the best strategies, partners and organizations that share our goal: ensuring Black women live longer, healthier, more prosperous lives. 


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