How to Become a Grassroots Lobbyist for Health Care Policy

My Position on AHCA 

Ensuring easy access to affordable and reliable health care is an important way of facilitating economic self-sufficiency. 

As such, I was fully in support of the implementation of the Affordable Care Act (ACA). 

I acknowledge that there are several components of the ACA that need to be revised, more specifically the mechanisms that put in check the costs to consumers such as the cost of pharmaceuticals, and increase in deductibles and co-pays. 

Nevertheless, the Affordable Care Act has proved to be effective in California. 

My position is that for the Affordable Care Act to be repealed, a viable replacement that will ensure coverage, access and affordability to all residents of California is needed. The American Health Care Act (AHCA) is not a viable replacement and should therefore be opposed. 

The American Health Care Act should be repealed for it will worsen the health situation of the most vulnerable residents of California. 

The AHCA does not address the key concern of a majority of California residents, which is to control healthcare costs. 

Apart from removing the mandate for employers to provide their employees with health insurance, the AHCA also pays particular attention to moving healthcare costs to states for Medicaid. 

The Act also eliminates cost-sharing subsidies and removes Planned Parenthood from reimbursement for services to patients on Medicaid. 

The American Health Care Act also excludes addiction and mental health coverage as key health benefits provided for by Medicaid. 

I strongly believe that these provisions will have a negative impact on the vulnerable members of the society, and will do little to control the constantly increasing costs of healthcare. 

The Rationale for my Position on AHCA 

It was in March 2017 that the American Health Care Act (AHCA) was brought before the House of Representatives. The Act utilizes the budget reconciliation process to bring about key changes in the Patient Protection and Affordable Care Act (ACA). In California, the ACA, passed by Congress in 2009, has proved to be quite a success, hence the concern about the changes the new Act has introduced. 

As a result of the ACA, uninsured rates all-over the country fell by a very big margin. In their examination of the early impact of ACA on young adults' health insurance coverage, Cantor et al. (2012) report that the ACA provision resulted in a rapid and substantial increase in the number of young adults with dependent coverage as well as a reduced uninsured rate. Their findings are supported by Shartzer, Long and Anderson (2016) who report that as a result of the ACA, there have been strong improvements in access to care, and better performance as far as affordability of care for adults, and low-income earners are concerned. 

In California, it is reported that the uninsured rate between 2013 and 2015 went down from 17.2% to 8.6%. This is a clear indicator that the ACA has been effective in California. The AHCA has its basis in the rationing formula known as per capita cap. This formula places a cap on the funds contributed by the federal government to states for each beneficiary of Medicaid, and at a rate that will not be able to put up with the growth in inflation. Moving Medicaid to a per capita cap increases the likelihood of coverage programs being cut and rationing of care. This will come as a great burden to most citizens. 

The Scenario Surrounding your Legislative visit 

In a bid to petition my congress representative to vote against the American Health Care Act, I made a legislative visit during which I presented a “leave behind.” In this leave behind, I highlighted the fact that the ACA has been quite successful, but several components need to be revised, more specifically the mechanisms that put in check the costs to consumers such as the cost of pharmaceuticals, and increase in deductibles and co-pays. I pointed out that for the Affordable Care Act to be repealed, a viable replacement that will ensure coverage, access, and affordability to all residents of California is needed. My opinion was that the American Health Care Act (AHCA) is not a viable replacement and should, therefore, be opposed. 

My representative in Congress was in opposition to the AHCA. As such, the "leave behind" served only to reinforce the representative's decision to vote against the Act. To support my representative's position, one of the point I would have highlighted is that the AHCA eliminates the individual markets protections that ensured that people could afford healthcare coverage under the ACA. The protections the new Act excludes include the 3-to-1 ratio for premium variation as well as a guaranteed issue that made it possible for the elderly and sickly individuals not to be priced out of the market. Under the AHCA, expansion states will also be required to re-examine eligibility after every six months. The Act will also bring down the retroactive coverage to a month from the current three months. The AHCA also sheds off the ‘reasonable opportunity’ period provided for by the ACA by requiring lawful presence documentation or citizenship to be availed at the time of enrollment. 

Another point I would make in support of the representative’s position is that per capita cap that forms the basis of AHCA places a cap on the funds contributed by the federal government to states for each beneficiary of Medicaid, and at a rate that will not be able to put up with the growth in inflation. Moving Medicaid to a per capita cap increases the likelihood of coverage programs being cut and rationing of care. I will also argue that the AHCA's primary focus is on transferring the healthcare costs to states, a move that will make it very difficult for citizens to access and afford healthcare services. 

As an experienced nurse, I have a clear understanding of the impact that the AHCA will have on the delivery of care. From my nursing experience, I understand that the cost of health care services has been increasing over the years and that the ACA has been quite effective in ensuring that a majority of Americans can afford healthcare services. The AHCA repels most of the provisions that have made health to be more affordable to Americans, and will thus reverse the gains that have so far been made. Through my nursing experience, I have been in direct contact with the local population and have heard an opportunity to listen to them complain about the ever-increasing costs of healthcare services. I am also aware that the demand for healthcare services has been on the rise, key drivers being increased prevalence of non-communicable diseases and the aging population. Proper policies that will make it possible for the population that is getting sickly over-time to access health care services easily are needed. As such, my position is, to a great extent, informed by my interaction with patients and members of the general public at the grassroots level. 

References 

Cantor, J. C., Monheit, A. C., DeLia, D., & Lloyd, K. (2012). Early impact of the Affordable Care Act on health insurance coverage of young adults.  Health services research ,  47 (5), 1773-1790. 

Shartzer, A., Long, S. K., & Anderson, N. (2015). Access to care and affordability have improved following Affordable Care Act implementation; problems remain.  Health Affairs ,  35 (1), 161-168.