People with HIV, LGBT people, and Black and Latino people would disproportionately lose health insurance under the Affordable Health Care Act

On May 24, the Congressional Budget Office (CBO) projected that the amended American Health Care Act (AHCA), which narrowly passed the U.S. House on May 4, would result in 23 million Americans losing their health insurance by 2026 as compared with what would be expected under continued implementation of the 2010 Patient Protection and Affordable Care Act (ACA).

“It is clear from the CBO analysis that the amended Republican health care plan is no better than the original bill,” said Sean Cahill, Director of Health Policy Research at The Fenway Institute. “Of the 23 million Americans projected to lose their health insurance under the GOP healthcare bill, children, older adults, and other vulnerable populations—including people living with HIV and lesbian, gay, bisexual, and transgender people—would be disproportionately affected.”

The ACA greatly expanded access to health insurance by permitting states to cover more residents through Medicaid, an insurance program funded jointly by the federal government and states that covers low-income people and those in need, including children and people with disabilities. The ACA also allowed for immediate coverage of those living with HIV via Medicaid without first requiring a diagnosis of AIDS.

The Medicaid expansions that have taken place in 32 states and the District of Columbia under the ACA have been crucial for expanding access to health insurance for lesbian, gay, bisexual, and transgender (LGBT) people, people living with HIV (PLWH), and Black and Latino people. Between 2013 and 2015, the rate of uninsurance among lesbian, gay, and bisexual people decreased from 22% to 11%. Between 2012 and 2014, the rate of uninsurance among people living with HIV decreased from 22% to 15%. During the same time period, uninsurance among Blacks was nearly cut in half, from 19% to 11%, while among Latinos it fell from 30% to 21%.

The bill passed by House members on May 4 would also permit states to opt out of ACA provisions that mandate coverage for preexisting conditions and essential health benefits such as cancer screenings. The CBO analysis found that premiums in states opting out of the ACA regulations would be 10 to 30% less expensive than they are now because health insurance companies would not be compelled to insure people with preexisting conditions equally or to provide coverage for essential health benefits. The CBO warned, “People who are less healthy (including those with preexisting or newly acquired medical conditions) would ultimately be unable to purchase comprehensive nongroup health insurance at premiums comparable to those under the current law, if they could purchase it at all.”

Additionally, the CBO estimates that premiums for older adults would skyrocket under the AHCA. A 64-year-old American with an annual income of $26,500 should expect to see their health insurance premiums rise from $1,700 a year under the ACA to between $13,600 and $16,100 a year under the AHCA.

“The American Health Care Act would make it much more difficult for people with pre-existing health conditions such as HIV, as well as older Americans, to obtain health insurance that is affordable,” Cahill added. “The CBO score confirms our earlier analysis that the American Health Care Act will make it harder to obtain coverage for health care, not easier.”

For more information, please see the following policy briefs:

“What the American Health Care Act means for LGBT people and people living with HIV”

“Amended American Health Care Act Poses New Threat To People Living with HIV, LGBT People”

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