This post has been updated to reflect amendments released on March 20.

Congressional Republicans finally have the opportunity to make good on their longstanding promise to repeal and replace the health law. In campaign rhetoric, they promised they could bring better, more affordable health care to Americans. Unfortunately, the replacement they’ve developed, known as the American Health Care Act (AHCA), doesn’t live up to that rhetoric. In reality, it would decimate historic health coverage gains in Oklahoma, leave the state on the hook for millions in Medicaid funding, and effectively double the uninsured rate by 2026. Here’s how.

The House Republican health plan would massively increase the cost of health coverage on the individual marketplace

Last year, more than 100,000 Oklahomans used a refundable advance premium tax credit to help pay for coverage purchased on Healthcare.gov. Under the Affordable Care Act, the premium tax credits are quite elastic, responding to enrollees’ age, income, and the cost of coverage where they live. In addition to keeping care affordable for enrollees – the average monthly premium paid by a 2016 enrollee in Oklahoma was $80 per month – this also insulated the vast majority of enrollees from premium spikes.

By contrast, the the House Republican plan calls for skimpier tax credits that only change with enrollee age, with no adjustment for income or geography. Under that plan, Oklahomans’ average tax credit would shrink by more than $4,600 by 2020, effectively losing nearly two-thirds of its value. In 2020, under current law, a 60 year-old Oklahoma couple earning $25,000 per year would be eligible for more than $31,000 in premium tax credits. By contrast, the House Republican health plan would give them just $8,000, effectively increasing their annual premium by more than $23,000 – nearly their entire annual income. Even in Oklahoma’s urban areas, families could see their premiums balloon to greater than half their yearly income.

In addition, the House Republican health plan would further increase older enrollees’ premiums by relaxing an Affordable Care Act provision restricting how much insurers can charge them. Because older enrollees tend to require more expensive health care, insurers naturally want to charge them more for coverage – but this can make coverage unaffordable for older people. The Affordable Care Act disallowed insurers from charging older enrollees more than three times what they charged younger ones. By contrast, the House Republican Health plan would allow insurers to charge older enrollees up to five times more – at the same time that they would decimate the value of the tax credits enrollees rely on to purchase coverage. 

Although House Republicans have promised some action to mitigate their plan’s effects specifically on Americans age 50-64, it’s not clear what that action might be – or if it would come close to replacing what current enrollees stand to lose under their plan. In addition, a recent amendment to the House Republican health plan would disallow enrollees who somehow didn’t spend their entire available tax credit on their premiums from depositing the remainder of the credit in a health savings account, for fear that those funds could be used to pay for abortions. 

The House Republican health plan contains unprecedented Medicaid cuts

The damage would extend to Medicaid, too. A vital safety net health care program funded by both state and federal dollars, Medicaid (known as SoonerCare in Oklahoma) provides health coverage for more than 800,000 Oklahomans per month, 2 in 3 of whom are children and 1 in 5 of whom are aged, blind, or have a disability. The House Republican would hobble Medicaid by putting a “per capita cap” on federal Medicaid funds to states or converting them to a block grant, regardless of actual health care costs. This is estimated to reduce federal Medicaid funding to states by 25 percent over the next decade. Oklahoma would have to make up the difference from its own budget – or cut provider reimbursements, coverage, or services. Thousands of Oklahomans, including seniors, people with disabilities, and children, could lose coverage or be parked on long waiting lists as a result. Making matters worse, an amendment to the House Republican health plan would allow states to institute work requirements for some adults who receive their health coverage through Medicaid. 

These cuts would do serious harm to Oklahoma families and communities. Many health care providers like rural hospitals and community health centers would not survive uncompensated care costs created by an spike in the uninsured rate, and thousands of vulnerable families would be at risk.  

What you can do

The House Republican health plan has already encountered significant opposition in its short life. By adding your voice to that opposition, we have a good chance of stopping it. Please contact your Congressional representatives and tell them you oppose the American Health Care Act and any other proposal that reduces access to health coverage for Oklahomans or restructures Medicaid.