Helpful Rebuttals to Arguments for ACA Repeal or Medicaid Block Grants/Per Capita Caps

Advocates should be prepared to push back against likely criticisms of the ACA and certain conservative proposals. This is critical so that lawmakers who state such talking points feel the pressure and discomfort with their current proposals from their constituents. We want them to think twice about towing the party line and want to hold them accountable when they state misleading points.

Don’t worry – we will replace the ACA with something terrific

  • Press them on the specifics of the plan – will it cover the same number of people? Will people get the same or more financial support? Will current enrollees keep their coverage? Will it cover the same services?
  • There is much talk about reducing costs, but reducing costs for whom? Will costs for low and moderate income beneficiaries go down? How will that be achieved?
  • Get them to explain how the replacement plan would impact your programs

We will retain the popular parts of the law, like prohibiting pre-existing condition discrimination, prohibition on annual and lifetime caps, and other insurance regulations

  • Press them for how they propose to keep the popular parts without the individual mandate. Other states have tried that and it has not worked. How do they plan to keep these requirements and still keep costs down?
  • They may mention requiring people to have ‘continuous coverage’ in order to qualify for insurance with a pre-existing condition. Continuous coverage means you cannot go without insurance, which is very difficult for low income families or people who experience a crisis like job loss or sudden health needs.

The ACA is collapsing on its own

  • Medicaid expansion is working great for our program and those we serve
  • Over one million people have gotten insurance through the ACA – about 650,000 in Medicaid and 350,000 on the Marketplace
  • More people have signed up on the Marketplace this open enrollment than ever before
  • The ACA needs improvement, but don’t throw the baby out with the bathwater. Why not just improve it? Repair the ACA rather than causing all this chaos.

Costs are spiraling out of control

  • Repealing the ACA will not help rising health care costs, which have been increasing for years – long before the ACA
  • The ACA has actually helped slow the growth of health care costs
  • Most of our program participants and neighbors with ACA coverage are on Medicaid or receive a subsidy, making coverage affordable

Don’t worry – the repeal is delayed

  • A delayed repeal will cause chaos – how can we plan for the future? How will the uncertainty affect the economic growth?
  • The Congressional Budget Office estimates that the non-group insurance market will likely collapse without a replacement, even if the repeal is delayed, leading to 18 million people losing coverage nationwide the very next year and premiums spiking after that

Medicaid expansion is crowding out the ‘truly needy’

  • Access to care for Medicaid enrollees has not diminished since Medicaid expansion – in fact, it has improved as providers have been able to invest in new staff and facilities thanks to Medicaid expansion dollars
  • Many who qualify under Medicaid expansion are truly needy. Most individuals experiencing homelessness and many of those struggling with severe mental illness or addiction qualify under Medicaid expansion.

Medicaid expansion has caused waitlists for seniors and people with disabilities

  • Waitlists have existed for many years and are actually increasing at a slower rate since the ACA was passed than they had the previous decade
  • Waitlists in Illinois are caused by insufficient funding of our home and community based services programs. Without Medicaid, this funding deficit would be much worse.
  • Access to nursing homes and home and community based services for seniors and people with disabilities is not limited by the Medicaid expansion population – it is limited by state funding and eligibility requirements. The infusion of federal dollars from Medicaid expansion has helped the state avoid further waitlists and restrictions.

Block grants will give the state needed flexibility in its Medicaid program and control costs

  • Governor Rauner has so far expressed concern about Medicaid block grants. Aren’t you concerned about how this could impact our state and our precarious budget situation?
  • All Medicaid block grant proposals and similar reforms would dramatically cut federal funding and shift costs to the states. This will harm my program and the state.
  • States need resources in order to be innovative and take advantage of any flexibility –how can we be innovative with significantly less money?
  • There is nowhere to reduce Medicaid spending further in Illinois. Medicaid spending has grown much more slowly that private insurance and Illinois has very low rates.
  • The Illinois behavioral health 1115 Medicaid waiver is very innovative and crafted under the current Medicaid structure. But it needs resources and Medicaid expansion to work!
  • Most of the flexibilities we’ve heard about are work requirements, waiting lists, and higher costs for Medicaid beneficiaries. The people we serve who depend on Medicaid will have a hard time meeting those requirements because of their circumstances. What happens to them? They will likely end up in the ED, a hospital or institution, or jail if they go without care.