2. States would be able to obtain waivers to allow insurers (by “re-defining” them) to opt out of providing certain “essential health benefits” that under the ACA include: outpatient care; visits to the emergency room; hospitalization; maternity and newborn care; mental health services and addiction treatment; prescription drugs; rehabilitation to help recover from injury, disability, and chronic physical and mental conditions; laboratory services; preventive services; and pediatric services. There are concerns that insurers would likely not cover maternity care and mental health, as most did not before it was mandated by the ACA. Also, under the option to “re-define” what constitutes “essential health benefits” insurance companies could re-impose lifetime and annual dollar limits on coverage.

3. There would no longer be an “individual mandate”—taxing people who do not purchase health insurance. (However, young healthy people would no longer feel obligated to get health insurance, likely making the general pool of people with insurance pay for more expensive premiums to compensate, because they may be the only ones who may feel the need to buy insurance due to chronic illnesses.)

4. The new plan allows states to obtain a waiver for insurers to opt out of the ACA “community rating” requirement to charge all people regardless of their health status and preexisting conditions the same premium. This would go into effect if people did not maintain continuous health coverage. Thus, for example, if a person loses his or her job and cannot afford COBRA and is forced to drop coverage, this individual can be charged a higher premium when he or she seeks coverage again. The bill imposes a 30% surcharge to regain coverage and includes people with preexisting conditions.

5. To help states support those with preexisting conditions who now may again be charged higher premiums, the government would provide $8 billion over 5 years to finance high-risk pools, but the evidence shows that this will be inadequate and funds will run out leaving people with preexisting conditions in dire straits.

6. Individuals who buy private insurance on their own would receive tax credits no longer based on income as it was with the ACA but rather based on age. For example, if you are a young person with an entry-level job who has a serious medical condition and there was a lapse in your coverage, you can be charged a higher premium and you will not get as much of a tax break as an older person making a substantial salary. However, the AHCA also discriminates against older people because under the ACA, there are restrictions on how much insurers can charge the oldest individuals, whereas the AHCA allows insurers to charge up to 5 times as much as the youngest enrollees—steeply driving up costs for older Americans who may be retired and sickly and unable to afford the increase even with a tax break.

7. The AHCA will repeal taxes on wealthy people, insurance companies, pharmaceutical companies, and medical device makers while it imposes burdens on middle and lower class Americans.

8. Under this legislation, Planned Parenthood would not be funded for 1 year and family planning services would not be a mandatory covered service in states electing Medicaid block grants. Tax credits could not be used for insurance plans that cover abortion services (except in the case of saving a woman’s life, rape, or incest).

9. This healthcare bill repeals funding for the Prevention and Public Health fund, which currently provides approximately $1 billion annually to the Centers for Disease Control and Prevention to manage disease outbreaks, prevent bioterrorism, provide immunizations, and heart disease screenings.

10. The one good thing: children will be able to remain on their parents’ health insurance plans until age 26.

In a recent White House Rose Garden ceremony, President Donald Trump said of the AHCA, “Yes, premiums will be coming down; yes, deductibles will be coming down, but very importantly, it’s a great plan.” However, there does not seem to be any hard evidence of this, and it appears that the latest public opinion polls support the views of professional organizations, with 60% of Americans opposing the new American Health Care Act, 31% supporting it, and 9% undecided. But the good news is that many experts and key stakeholders including the ANA and AHIP are prepared to help with the next steps, stating, “We [AHIP] stand ready to work with members of the Senate and all policymakers, offering our recommendations for how this bill can be improved to ensure the private market delivers affordable coverage for all Americans.” So it will be shortly on to the Senate, where the plan is likely to include substantial revisions…might we suggest restoring it to its previous form, also known as, the Affordable Care Act?

Judi Greif, MS, RN, APNC, is a family nurse practitioner residing in East Brunswick, New Jersey.