Woman with medication
July 13, 2017
by Thao Nguyen and Kim Prendergast

The majority of households seeking help from the Feeding America network have had to choose between food and medicine. For the millions of Americans who struggle to put food on the table, the health care reform debate is very real — and critically important.

As Congress considers repealing and replacing the Affordable Care Act (also known as the ACA or Obamacare), these are the three things about the health care debate and hunger you should know, and lawmakers should be thinking about:

  1. Medicaid is a critical way people struggling with hunger get their health coverage.

    With the ACA’s expansion of the Medicaid program, 14 million Americans have gained health care coverage — many for the first time. But the households Feeding America serves may be hardest hit if the Medicaid expansion program is eliminated.

    The American Health Care Act (AHCA) recently passed by the House would eliminate the Medicaid expansion program by 2020, and the current Senate version of the bill would start phasing out Medicaid expansion by 2020 and completely eliminate it by 2024. Both health care plans would restructure the entire Medicaid program by capping funds the federal government would provide states. This shifts the cost of providing healthcare to state governments, likely resulting in a decrease in the number of people who have health insurance and a reduction in access to care in times of need.

    A health care proposal that works for people struggling with hunger must ensure the Medicaid program is strong — providing both comprehensive coverage without shifting the burden of paying for the program to states or low-income families.

  2. Food insecurity increases risk for chronic disease. Without affordable health coverage, people with chronic diseases will not be able to get the health care they need to improve their conditions.

    People struggling with hunger may be hard hit by a health care system that charges higher premiums for those with pre-existing conditions or allows health plans to severely limit the type of services they provide. Many of the people we serve say they are in poor or only fair heath. And the majority of people struggling with hunger are forced to purchase cheaper foods that are not the healthiest options, which can contribute to obesity, heart disease and diabetes.

    Currently, the ACA guarantees the following for all Americans:

    • Insurance companies can’t deny you coverage because of a pre-existing condition
    • Insurance companies also cannot charge people who are sick more for the health plan
    • Essential health benefits, meaning guaranteed access to basic services like maternity care, mental health and prescription drugs

    The health care proposals being considered by Congress roll back these protections:

    • Both the AHCA and the Better Care Reconciliation Act (the Senate’s version of the health care reform bill) allow insurance companies to charge those that are older — and more likely to have pre-existing conditions — premiums five times higher than what they charge those who are younger
    • Both bills would allow states to get waivers to scale back the types of conditions they cover
    • The House’s bill would go one step further and allow health plans to charge those with pre-existing condition more for their healthcare. This could potentially make health care access completely unaffordable for those who have conditions like diabetes or high blood pressure
  3. Plans that heavily rely on tax credits don't help low-income people.
  4. Tax credits that help pay for health care premiums are critical for Americans to get affordable care. However, tax credits don’t provide the necessary help that some of the lowest-income families need.

    Currently, the ACA provides tax credits to people that make between 100 to 400% of the federal poverty level. The law was written with the understanding that all states would expand the Medicaid program to ensure that the most low-income Americans received coverage. With some states not taking on the expansion, very low-income people can make too little money to qualify for a tax credit and have no chance at coverage at all under the current law.

    The bill passed by the House and the Senate proposal exasperates this issue by relying on a different — and less generous calculation — to provide tax credits. With both the degradation of the Medicaid program and the less generous tax credits, these plans would force many of the people served by the Feeding America network back into situations where they are choosing between food and medicine.

Millions of Americans should not have to choose between putting food on the table and going to the doctor. The right health care proposal for our country would not force families to make this impossible choice. Feeding America hopes any health care proposal would not place additional financial burdens and stress upon low-income families who are already working hard to make ends meet.

Learn more about the effects of hunger on health and the intersection of hunger and poverty.

Tags: Fighting Hunger in Action

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