By Beverly George, ACE Leader

After Rahul Nayak introduced himself, he asked attendees to introduce themselves so that he could get to know his audience. This personal reaching out and connecting was an integral part of the well-engaged conversation that followed.

Nayak was quite familiar with the Affordable Care Act and the proposed American Health Care Act from the House, but the Senate had only released their BCRA two days before. Therefore, Nayak filled members in on many of the provisions and protections within the ACA as law, and what the consequences would be if AHCA or the Senate BCRA were to replace it.

ACA not in a ‘death spiral’

Rahul Nayak explained clearly with data and graphs, the rising cost of American health care since 1980. Comparing the U.S. to eleven other western countries that provide quality healthcare, the cost of American health care rose much faster until 2009 when the ACA was passed, and, for 2009-2013, the costs clearly leveled out. In addition, the CDC reports the rate of uninsured Americans dropped dramatically from a high in 2010 of 16% down to 9% in 2015.

Nayak emphasized the ACA has shortcomings that need repair, but it is definitely not in the “death spiral” often cited by Republican legislators. The key provisions most Americans know well include Medicaid expansion, creation of the individual insurance market, consumer protections, and children 18-26 allowed to stay on their parents’ plans.

Consumer protections are worth separate emphasis here because the ACA mandates ten essential health benefits–ambulatory and emergency services; hospitalizations; maternity/newborn services; mental health services; prescription drugs; rehabilitation; laboratory services; preventative/wellness care; and pediatric services (e.g., oral/vision). In addition, there are no lifetime maximums, no annual maximums, no denials for pre-existing conditions, guaranteed renewals, insurance premiums based only on age and geography, and the right to an external appeals process.

Before the ACA, insurance was tied to employers; exclusions were allowed providers for pre-existing conditions; plans provided limited preventive coverage; plans were often inadequate and fraught with “gotcha” clauses and tight caps on benefits; and in general, Americans faced a much higher risk of bankruptcy from a serious accident and resulting injuries, or a cancer diagnosis.

AHCA and BCRA not really about health care

With this background in mind, Nayak emphasized the Republican Plan is not really about health care at all. The long-term Republican goal is to pass massive tax cuts over two years. Using the budget reconciliation process (under which only one is allowed per year), the AHCA or BCRA would repeal ACA in FY 2017. Congress would then follow in FY 2018 with a tax reform package.

Both legislative measures are designed to subsidize the wealthiest Americans over two consecutive years, and this will be achieved on the backs of the poor, the working poor, middle-income Americans, the disabled, those with mental health problems and addictions, older Americans (45-65), and the elderly in long-term care. For these vulnerable citizens, health care will no longer be affordable, making a further discussion of accessibility pointless. Income-based subsidies will be replaced with age-based tax credits (advantageous to the young but penalizing older Americans). In addition under AHCA and BCRA, subsidies for insurance will be rolled back, and there will be huge cuts to Medicaid funding as the federal government limits its role in Medicaid by sending fixed per capita sums to the states.

An economic repercussion seldom discussed is the number of good jobs that will be lost. The ACA has brought with it additional jobs in the medical profession and health service industries, in both urban and rural America. These jobs will be lost and facilities closed when 22-23 million Americans can no longer afford to use these health services.

How will Illinois fare with the proposed legislation?

Nayak emphasized that here at home, the implications for Illinois are alarming. In 2017, there were 356,403 Illinoisans enrolled in the exchanges. There were 648,000 Illinoisans covered by Medicaid Expansion in 2016. In the IL-06 district (Rep. Peter Roskam), 61,000 would lose coverage with full ACA repeal (the most in the state). In the IL-11 district (Rep. Bill Foster), 58,000 would lose coverage with full ACA repeal.

In addition, the AHCA Medicaid funding formula would severely hamper Illinois’ future state budgets. Keep in mind that future funding is based on current per capita spending, and sadly, Illinois ranks 46th in the nation, spending a meager $4856 per capita, while Indiana spends $7434, Iowa spends $6897, and Wisconsin spends $6680.

Under AHCA, there are NO provisions in the Medicaid formula to allow for an aging population or future medical innovation.

Yet every Illinois congressional Republican voted FOR the AHCA. Other than Democratic legislators, what organizations oppose the proposed replacement legislation? The list includes the American Medical Association, the American Nurses Association, the American Hospital Association, AARP, and #Protect Our Patients, an organization of future medical providers who advocate for keeping and improving the ACA, based on the moral mandate to “first, do no harm.”

Rahul Nayak provided a full understanding of how the ACA has worked, where it needs improvement, and what’s involved in a plan to repeal and replace. Several members commented on how they had gained a much better understanding of how things work with the ACA in place and what’s at stake with changes.

Members left with a message: it’s time to speak out, to act, connect, and engage. Illinoisans have too much skin in this game.


Rahul Nayak was the guest speaker at the ACE general meeting on June 25th. Nayak is a 2009 graduate of Naperville North High School, a 2013 graduate of Duke University (Biomedical Engineering and Economics), a NIH Fellow On-Call with Bioethics Consultation Service 2013-2015, and has recently completed his second year at Harvard Medical School.

ACE Leader Beverly George also is a member of Indivisible, the Naperville League of Women Voters, and the Citizens Climate Lobby. She also volunteers with her parish PADS group. A former chemist, George worked in clinical chemistry and hematology research at the Centers for Disease Control for six years and taught chemistry and freshman science at Naperville North High School for 20 years.