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Repeal and Replace Considerations under the AHCA: Elevating healthcare access by needy residents and provider reimbursements

By Lorianne Maria Sainsbury-Wong posted Sun June 11,2017 07:40 PM


Access to healthcare insurance supports our local communities and Massachusetts’ infrastructure and economy. Health care is also prerequisite for residents to uphold productive lives, and it preserves individual liberties and happiness. Unmet healthcare needs, on the other hand, stigmatize impoverished and disadvantaged communities and undermine the functionality of a healthcare system by diverting dollars from preventive care providers to more costly episodic interventions. "To allow a serious illness to go untreated until it requires emergency hospitalization is to subject the sufferer to the danger of a substantial and irrevocable deterioration in his health. Cancer, heart disease, or respiratory illness, if untreated for a year, may become all but irreversible paths to pain, disability, and even loss of life. The denial of medical care is all the more cruel in this context, falling as it does on indigents who are often without the means to obtain alternative treatment." Memorial Hospital v. Maricopa County, 415 U.S. 250, 261 (1974) (footnote omitted).

The American Health Care Act (AHCA) would repeal and replace the 2010 Affordable Care Act (ACA). Last week the Senate Budget Committee announced that the AHCA does comply with budget reconciliation rules. “[O]nce Congress makes its choice in enacting legislation, its participation ends. Congress can thereafter control the execution of its enactment only indirectly— by passing new legislation.” Bowsher v. Synar, 478 U.S. 714, 733-34 (1986). On a national level, policy decision makers and all of us as stakeholders in this crucial discussion are justifiably concerned.   

According to recent findings of the Congressional Budget Office, AHCA enactment would cause approximately 23 million residents nationwide to lose coverage by 2026.  See CBO Cost Estimate, H.R. 1628, AHCA of 2017 (dated 5-24-17). The CBO report also evidences a 17% increased rate of uninsurance among low-income adults between the ages of 50-64. Inaccessibility of coverage not only causes medical debt among consumers and propels more costly future medical needs but also it jeopardizes the financial sustainability of medical providers and facilities. Lack of medical care by low and moderate income individuals and families poses substantial liabilities on patients, providers, and the communities at large. Moreover, effective January 2020, the AHCA would repeal increased rates of federal matching funds to states, like the Commonwealth, that have expanded Medicaid. Medicaid, as we know, is a critical federal and state program that delivers medical care and provider reimbursements for treating indigent individuals and families. It is an essential governmental privilege that supports an individual’s healthcare access and provider reimbursements. Qualified Medicaid beneficiaries are entitled to constitutional protections. See Goldberg v. Kelly, 397 U.S. 254, 264 (1970).

Invidious distinctions between classes of citizens, particularly those that subject residents to health disparities, should be scrutinized under rigorous standards. Governmental benefits that are essential to basic sustenance underscore the need for greater constitutional protections. Although healthcare access is not a fundamental right, it rises to the level of one of our most critical day-to-day necessities and promotes the well-being of consumers, providers, and our society.

Lorianne M. Sainsbury-Wong | MBA Civil Litigation Council Member | MBA Health Law Section Council, Past Chairperson


Note: This article was prepared in my personal capacity. Any opinions expressed here are my own and do not necessarily reflect the views of the Massachusetts Bar Association (MBA) or of my employer, Health Law Advocates (HLA), One Federal Street, Boston, MA 02110 | 617-338-5241 |


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