Although the American Health Care Act, or AHCA, failed to attract enough votes to advance last week, the ideas contained within the bill have long been popular with conservatives and will likely be introduced again in the future, according to the authors of a new policy brief on the proposed legislation from the UCLA Center for Health Policy Research.

In the study, the authors found that older and low-income Californians who buy insurance on the individual market would have shouldered drastically higher costs for health premiums under the new act. Conversely, young and wealthier groups would have benefited.

Census Bureau figures report that about 20 million Americans gained access to insurance under full implementation of the Affordable Care Act, or ACA, including 3.7 million in California, according to the National Health Interview Survey. However, passage of the Trump administration’s proposed law, which would have replaced the Affordable Care Act, was projected to increase the number of uninsured Americans from 26 million in 2017 to 41 million next year and 52 million by 2026, according to the Congressional Budget Office.

“The American Health Care Act was a public health disaster and its defeat is a victory for all Americans,” said Gerald Kominski, director of the UCLA Center for Health Policy Research and co-author of the policy brief. “But the fight is not over. Those opposed to the ACA will continue to try to kill it by regulatory and other means.”

The policy brief focuses on how the proposed law would have affected both Californians who buy insurance on the state health exchange, called Covered California, and those who buy private insurance without subsidies, totaling about 2.35 million people, according to 2015 data from the California Health Care Foundation.

The brief breaks down the financial winners and losers in California by age and income. Authors compared average 2020 tax credits for the Affordable Care Act and the American Health Care Act and found that a single 60-year-old with an annual income of $20,000 would lose more than $7,700 in tax credits — a 66 percent cut — under the proposed act, while a single peer earning $75,000 would get $4,000 more in tax credits. Young, poor singles would have a similar fate, although they would see a smaller reduction: A 27-year-old who makes $20,000 annually would have nearly $2,000 less to pay for insurance under the proposed act, while a peer who earns $75,000 would receive $2,000 more in tax credits.

The proposed health care act also hit older California couples hard: A 60-year-old couple with no dependents earning $20,000 a year would have lost more than $16,000 in benefits, a 67 percent drop. However, their peers who earn a combined $100,000 would have gained an $8,000 tax credit, and a 40-year-old couple with two young children and an income of $150,000 would have qualified for a $10,000 tax credit.

Although the bill was declared dead when a vote on the legislation was canceled, the authors note that the Trump administration has already begun to make fundamental changes to the current law outside of legislation, including proposed rule changes that would weaken patient protections and make it more difficult for people to enroll in coverage.

“This set of proposed rules is likely just the first of many that the administration will put forward to undermine the law,” said Petra Rasmussen, co-author of the brief and a Ph.D. student in Health Policy and Management at the UCLA Fielding School of Public Health. “The policy ideas that were included in the AHCA are ones that Republicans have been touting for many years and they won’t go away with just one bill’s defeat.”

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