Rare Disease Report

No Voting on TrumpCare: Going to Let ObamaCare 'Explode'

MARCH 24, 2017
James Radke
Following a long day of 'will they or won't they get the get the votes', Speaker Paul Ryan removed the American Health Care Act (AHCA) from being voted on by Congress late Friday afternoon. It was determined that the bill would not get the 215 votes needed to gain approval.

In a press briefing, President Trump blamed the Democrats for not supporting the bill and seemed to imply that the current administration is going to wait for the current Affordable Care Act (ObamaCare) to ‘explode’.
The President said:
“So what would be really good, with no Democrat support, is if the Democrats, when it explodes -- which it will soon -- if they got together with us and got a real healthcare bill.  I would be totally up to do it.  And I think that's going to happen.  I think the losers are Nancy Pelosi and Chuck Schumer, because now they own Obamacare.  They own it -- 100 percent own it.  

"And this is not a Republican healthcare, this is not anything but a Democrat healthcare.  And they have Obamacare for a little while longer, until it ceases to exist, which it will at some point in the near future.  And just remember this is not our bill, this is their bill.

"Now, when they all become civilized and get together, and try and work out a great healthcare bill for the people of this country, we're open to it.  We're totally open to it.”

When asked by a reporter if it was fair to simply let ObamaCare ‘explode’, the President responded:
“Well, it's going to happen.  There's not much you can do about it.  It's going to -- bad things are going to happen to Obamacare.  There's not much you can do to help it.  I've been saying that for a year and a half.  I said, look, eventually it's not sustainable.  The insurance companies are leaving -- you know that.  They're leaving one by one, as quick as you can leave.  And you have states, in some cases, who will not be covered.  So there's no way out of that.

But the one thing that was happening, as we got closer and closer, everybody was talking about how wonderful it was, and now we'll go back to real life and people will see how bad it is.  And it's getting much worse.”


American Health Care Act and Rare Diseases

Last week, the National Organization of Rare Disorders (NORD) stated they do not support the AHCA in its current state and listed the various good and bad points about the bill with respect to its impact on the rare disease community. 

  • Insurance protections for patients with pre-existing conditions remain, such as guaranteed issue and renewal of coverage, prohibition on discriminatory benefit exclusions, and mandated community rating. 
  • The ban on annual and lifetime limits remains, and maximum out-of-pocket caps will continue to protect patients from undue financial burdens. 
  • The AHCA also allows children to stay on their parents’ plan until the age of 26 years.
  • Anti-discrimination provisions from the ACA remain, as well as the Concurrent Care for Children provision that allows children in hospice to be eligible to receive life-saving therapies.

  • Additional changes to Medicaid may jeopardize the health and wellbeing of Medicaid beneficiaries with rare diseases. Further, NORD is concerned about the effect instituting per capita cap allotments may have on medically necessary care for individuals with rare diseases. Individuals with rare diseases are already facing Medicaid access challenges in many states, and we believe cutting Federal contributions may worsen the situation. 
  • The AHCA maintains Medicaid expansion until 2020, but the proposal no longer may or may not allow for additional enrollment under Medicaid expansion after 2019.
  • The AHCA also removes additional Federal assistance for the 1915(k) Community First Choice program after 2019. This program allows for state Medicaid programs to cover patients wishing to receive skilled-nursing care in the comfort of their own home rather than in a nursing facility.
  • The continuous coverage penalty of an additional 30% of premiums does not appear to accommodate any valid reasons for going uninsured for more than 63 days.
  • The AHCA replaces ACA subsides with age-based tax credits, a system NORD believes could overburden low-income individuals with rare diseases and their families.

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