On March 6, 2017, the leadership of the U.S. House of Representatives introduced long-awaited legislative text intended to repeal and replace the Affordable Care Act (ACA) utilizing budget reconciliation, the fast-track legislative procedure that only requires a simple majority vote in the Senate. The two bills were drafted by the U.S. House committees with jurisdiction over healthcare: the Energy and Commerce and the Ways and Means Committees (Energy and Commerce text can be found here and Ways and Means text here). Both committees began marking up their bills on March 8, 2017 before combining them into a larger package that is being called the “American Health Care Act.”
Counties are the front door to the nation’s health system, investing $83 billion annually—or about one of every five dollars of their budgets—in community health systems. Counties help support 961 hospitals, 883 skilled nursing facilities, 750 behavioral health authorities and 1,943 public health departments. In addition to providing care to Medicaid beneficiaries, counties help some states administer the program and contribute to the non-federal share of Medicaid funding in 26 states. Since 1965, the Medicaid program has been essential to helping counties meet their often-mandated obligations to provide healthcare to low-income individuals.
At this point, the American Health Care Act (AHCA) does not have a Congressional Budget Office score or coverage estimates, and therefore it is difficult to accurately determine how the proposed legislation would fully impact counties in their multi-faceted roles as payers, providers and administrators of health services and stewards of local taxpayer dollars. However, in our initial analysis of the policy provisions, there are several ways that counties would likely be impacted by the proposed legislation:
- The proposed legislation would fundamentally alter the important federal-state-local partnership for Medicaid and reduce Medicaid coverage levels.
- The proposed legislation could have indirect and direct impacts on county health systems, including county public health departments.
- The proposed legislation retains the 40 percent excise tax on employer health benefits included in the ACA.
NACo will continue to analyze potential impacts of the “American Health Care Act” and other legislative proposals while working with Congress to ensure our counties remain healthy, vibrant and safe.
Additional NACo Resources:
- Presentation on Medicaid and the role of counties
- Policy Brief on Medicaid
- Policy Brief on the Prevention and Public Health Fund (PPHF)
- Policy Brief on Health Services for Justice Involved Individuals
- Policy Brief on SAMHSA
- Policy Brief on repeal of the 40% excise tax on employer-sponsored health care