Today, the United States Senate voted to proceed with debate on a bill to either repeal the Affordable Care Act (ACA) or one that would repeal and then replace the ACA. There is no text of the bill available for the public to review and the Congressional Budget Office (CBO), which provides Congress with nonpartisan analysis of legislation, will not have an opportunity to project the likely impact of the bill before Senators vote.
The vote will take place sometime tomorrow, July 26, 2017.
A bill put forward by the Senate in June would result in an estimated 22 million Americans losing their health insurance by 2026 as compared with what would be expected under continued implementation of ACA, according to the CBO. In May, the CBO estimated that a bill narrowly passed by the House of Representatives would result in 23 million Americans losing their health insurance by 2026.
“We don’t know what’s in the bill that senators are debating and preparing to vote on,” said Sean Cahill, Director of Health Policy Research at The Fenway Institute of Fenway Health. “Thus far, however, every bill proposed by Congress to replace the ACA would result in harm to LGBT people and people living with HIV, and that would be devastating to the health of these communities.”
More than 20 million Americans have gained health insurance under the ACA, and from 2013 to 2015—after key provisions of the ACA that expanded eligibility for Medicaid went into effect—rates of uninsurance among lesbian, gay and bisexual people were cut in half, from 22% to 11%. Over the same period, rates of uninsurance among low-income transgender people dropped from 59% to 35%. Between 2012 and 2014, rates of uninsurance among people living with HIV dropped from 22% to 15%. Over the same period, rates of uninsurance among Black Americans dropped from 19% to 11%.
The Fenway Institute has released several policy briefs on the impact that repeal of the ACA would have on lesbian, gay, bisexual, and transgender (LGBT) people, as well as people living with HIV. Various bills that have been proposed would end the expansion of Medicaid permitted under the ACA and make additional cuts to the program. The Senate bill put forward last month would allow states to opt out of many of the ACA’s health insurance requirements, including rules for what constitutes a qualified health plan and what health benefits must be covered. The ACA currently requires coverage of essential health benefits, including HIV/STI screening and behavioral health care.
“These benefits are especially important for LGBT people, people who are living with HIV, and other vulnerable populations that are disproportionately burdened by health disparities and experience barriers to accessing healthcare,” Cahill added. “These changes would disproportionately harm LGBT people, people living with HIV, and people with other chronic diseases.”
The policy briefs related to the Congressional health care bills are Essential Elements of a Revised National Health Care Policy for LGBT People and People Living with HIV and What the American Health Care Act means for LGBT people and people living with HIV.