The purpose of this assignment is to imagine a visit to Miami’s representative in Congress to state the author’s position on the AHCA. To that end, it is necessary to construct a one-page document called a “leave-behind” that describes the main points of one’s stance and support it with a rationale. Furthermore, the assignment requires a brief outlining the circumstances of the visit, such as the representative’s position and the points covered during the presentation.
Although the implementation of the AHCA benefits the federal government, it is likely to have a negative financial impact on every state due to the need to compensate for reduced federal spending. Furthermore, just enacting the policies outlined in the act would not achieve its full intended impact, requiring additional measures to be taken by the states;
The increase in costs may force many states to eliminate coverage of the expansion population and reduce enrolment. That would lead to up to 12-15 million nonelderly people losing their coverage by 2022, depending on the number of states that make the decision;
The implementation of the act is likely to lead to the curtailment of home- and community-based services (HCBS), which were crucial to the well-being of almost 3 million people in 2013. Already limited due to financial constraints, HCBS are optional Medicaid benefits and may be removed altogether if there is not sufficient funding;
Repealing the ACA would lead millions of people to lose their Mental Health and Substance Use Disorder treatment and parity protections, which were enabled by the original act.
The Rationale for the Position
The position outlined in the “leave-behind” consists of four points, two of which are financial while the other two are medical. Blumberg, Buettgens, Hollahan, and Pan (2017), who calculate the economic impact of the AHCA and make hypotheses about the possible responses from the states and how they would affect the results, describe the first two. The reduction of HCBS is outlined by Solomon and Schubel (2017), who claim the necessity of the services will only increase, which would lead to states removing them altogether, as they are unable to sustain the funding. Lastly, Wishner (2017) talks about the reduction in access to MH and SUD treatments, as the ACA required Medicaid to cover that area while the AHCA does not.
The Congress representative for Florida’s 24th district, where Miami is located, is Frederica S. Wilson, a member of the Democratic Party. She is not assigned to a committee that directly works with health issues, focusing on education, workforce, transportation and infrastructure. However, she displays a strong opposition to the AHCA, primarily on a financial basis. As such, she should be sympathetic to a legislative visit in opposition to the act.
As the representative is concerned for the financial side of the new act, it would be prudent to pay close attention to that aspect of the issue. I would stress that the economic benefits of the bill to the federal government would be balanced out by the increased costs for the states, as described by researchers (Blumberg et al., 2017). I would further explain the possible subsequent reduction of Medicare coverage outlined in the paper and note that the states would see minimal benefits even in that case.
However, finances should not be the primary concern when it comes to health care. As such, I would support the argument with a description of the medical issues that would follow from the repeal of the ACA, beginning with the danger HCBS are facing, according to Solomon and Schubel (2017). This problem is particularly relevant for me as a nurse, since these services are performed by my colleagues and me, and their removal would hurt the profession.
Lastly, I would explain the impact of the AHCA on the treatment of mental issues. Wishner (2017) describes the extended coverage for MH and SUD provided by the ACA as a decades-long effort, noting that the majority of people with employer-sponsored insurance had limits on behavioral health coverage before the act. The repeal of the ACA could destroy that achievement, as the reduction in Medicaid coverage and removal of parity protection would once again leave the majority of people financially unable to access the necessary services.
As a nurse, I believe that the AHCA concerns my profession especially strongly, as the nursing profession is growing and developing, and the reductions in health care spending could adversely affect that growth. HCBS are carried out almost entirely by nurses, which means their removal, combined with the decrease in the number of Medicaid-insured people, would considerably reduce demand for the occupation. Even if these measures are not implemented, the states would have to cut the provider payment rates, according to researchers (Blumberg et al. 2017), and as such nurses would still suffer from the AHCA.
I support my representative’s opposition to the AHCA, both for financial and medical reasons. Apart from increasing the states’ spending or reducing Medicaid coverage, access to critical services may be removed to reduce the operating costs of health care. Furthermore, the act endangers my occupation as a nurse, likely leading to reduced income or loss of workplaces. In the hypothetical visit to my representative in Congress, I would present these points as well as a “leave-behind” describing the main issues from the government’s perspective in the form of bullet points.
Blumberg, L. J., Buettgens, M., Holahan, J., & Pan, C. (2017). High-risk pools under the AHCA: How much could coverage cost enrollees and the federal government? Web.
Solomon, J., & Schubel, J. (2017). Medicaid cuts in House ACA repeal bill would limit availability of home- and community-based services. Web.
Wishner, J. B. (2017). How repealing and replacing the ACA could reduce access to mental health and substance use disorder treatment and parity protections. Web.