House Republicans unveiled the American Health Care Act (AHCA) on Monday. The bill revises key parts of the Affordable Care Act (ACA), also known as Obamacare.

The AHCA would gradually decrease the Medicaid expansion of the ACA back down to its original levels, repeal the individual mandate and replace subsidies with tax credits to help people afford insurance.

According to estimates from the U.S. Census Bureau, the ACA decreased the number of uninsured in Michigan from 1.2 million in 2010 to 600,000 in 2015. Michigan is one of 31 states that expanded Medicaid under the ACA, and Republican governor Rick Snyder called the expansion “a great success” that “has saved millions of dollars in Michigan’s health care system.”

Health professionals, nursing students and Calvin professors described how the ACA affects Grand Rapids and what changes the ACHA might bring, if passed.

Mike Reagan, chief external relations officer for Cherry Health in Grand Rapids, explained that Cherry Health has seen a corresponding decrease in the number of uninsured patients they cover, declining from 38 percent of their patient population to 24 percent. Additionally, the number of patients they served increased from 56,894 in 2012 to over 70,000 in 2016.  

As a federally-qualified health center, Cherry Health receives reimbursement from the federal government for providing healthcare to underserved populations. Reagan noted that in this mission, Cherry Health has seen an increase in the number of medically-underserved patients of over 18 percent, or over 13,000 new patients. A majority of the patients they see have an income under 138 percent of the poverty level and are thus covered under the expanded Medicaid program of the ACA.

Reagan noted that the ACA stipulates free preventive services such as cancer screenings and annual physicals as part of insurance plans. These preventive approaches “reduced the number of individuals unnecessarily using emergency room care and accessing primary care when they needed it” which has reduced costs on the medical system of treating uninsured people.  

Klara Oh, a Calvin nursing student, works in the Heartside neighborhood, which has a large homeless population. The nursing department has seen a significant decrease in the number of uninsured in their neighborhoods since the ACA was passed.

While the number of uninsured has decreased, Oh said she still runs into a lot of people who do not have health insurance. Information on health care coverage is “not necessarily presented in an accessible way. There are so many people who don’t know how to get insurance or where. The Calvin nursing students have to do a ton of networking to connect people with the right resources so that they get the care they need.”

Calvin public health and sociology professor Kristin Alford is dismal about the prospect of reform. She explained that “the ACA has been instrumental in increasing access to health care, breaking down barriers to obtaining health care and promoting preventive services.”

Alford is particularly worried about the Medicaid expansion cap, which she thinks will leave many once again without insurance. Alford also mentioned the possibility of rising costs with the new bill as insurance companies cannot deny coverage to people with pre-existing conditions but healthy people have less incentive to buy insurance.

“The takeaway from this all for me is that if this passes it will be just fine or even better for those who are well-off (middle class and wealthy), but those who will suffer from this legislation are those who are lower-income and who already face major access issues,” Alford summarized.

Professor Mikael Pelz of Calvin’s political science department emphasized that the ACHA is focused less on repeal and more on tweaking existing healthcare policy. “We are in the same policy regime [as the ACA], and not starting from scratch,” Pelz said, trying to dispel anxiety about the repeal efforts.

He thinks it unlikely that Democrats will completely throw out the Republican replacement for the ACA if they regain a majority in Congress, so “this health policy framework will be the one we are working within for the coming decades.”

Pelz added that students should care about healthcare reform efforts because “when students are purchasing their first healthcare policy, what is covered under it, how much it costs and what government help is available to afford that policy is all being debated right now.”