The national health insurance program (NHI) warned on Thursday that the U.S. would likely face “unexpected and severe consequences” if Congress fails to pass the American Health Care Act (AHCA) by the end of March.
“The ACA is going to be the biggest challenge we’ve ever had in terms of making sure the government is paying out,” Dr. David Himmelstein, the director of the NHI, told reporters in New York City.
“If the government does not pay for all of the things that we’re asking for, that will be the first casualty for us.
And then we’re going to have to come up with some way to pay for the other things.”
Himmelsteins comments came as Republicans in the Senate were poised to pass their bill to repeal and replace the Affordable Care Act, known as Obamacare, in a fast-tracked vote on Thursday.
If it passes, the bill will then be sent to the House for consideration, where it faces opposition from conservatives and moderates who have pledged to vote against it.
The Trump administration has signaled it would veto any legislation that did not include funding for the Medicaid expansion, the healthcare program for low-income Americans.
But if it fails to fund the expansion, Republicans are likely to argue that the AHCA, which would have forced states to expand Medicaid under the ACA, violates the Constitution by forcing states to fund Medicaid through a “block grant,” which provides funds to states in proportion to the size of their population.
The AHCA would require states to “block grants” to expand health care, which critics say is tantamount to a subsidy, which they say violates the Tenth Amendment, which prohibits Congress from making any law which “restricts the freedom of contract.”
“The block grants would be essentially an insurance company subsidy for states to do what they’re supposed to do,” said David L. Hochberg, a professor of health policy and management at Harvard University who has written extensively on the impact of the AHca on health insurance markets.
The block grant provision would “give states the power to provide insurance to a larger population in a way that was not available under the law,” Hochenberg said.
“This could be a big problem for insurers if states want to provide coverage to all their residents.
But the ACA doesn’t require that.”
Insurers have warned that the block grants are a big risk for the AHcas revenue streams.
Himmelman said he would like to see the block grant funding included in the bill, but was not willing to speculate as to what could happen if it does not.
“I don’t want to give you a lot of guesswork here,” Himmelman told reporters.
“The ACA was supposed to be very robust, and we’re in the process of repealing it.
But it’s a very complicated bill.
And if it’s not included, then you’re going down a very rocky path.”
The White House and the Trump administration have repeatedly insisted the AH cements a level playing field between the states and the federal government, with both states and states getting the same federal dollars to expand access to healthcare for all Americans.