Past the House and on its way to the Senate Floor, the AHCA Beta version (aka Trumpcare) makes big changes to the current Affordable Care Act (ACA)(aka Obamacare).
While there’s not yet a CBO assessment on the newest version (this in itself should cause one to question if this has been thought through enough), the bill has big implications to the cost, amount, and quality of healthcare Americans would receive.
Senator Paul Ryan this week argued that the changes continue to make healthcare accessible to everyone. But, access requires affordability, something that many of the proposed changes to the AHCA eliminates for many of the neediest Americans. Here’s why.
> You no longer will be penalized (fined) if you don’t have insurance coverage, so you’re no longer effectively required to have it. You can also use the subsidies (which now become credits) to purchase insurance outside of the ACA marketplaces.
However, the credit increases with age, but no longer considers family income and local cost of insurance. Thus, there could be a lot of discrepancy on what individuals pay across the country, as this graph and article show.
Because the ACA is primarily used by those with lower incomes who don’t have access to healthcare via their employer, premium costs will likely rise significantly for these folks, making healthcare more unaffordable. Thus, while plans may be out there, they will be out of the grasp of many because of the cost. Meanwhile, those with higher incomes but who don’t get financial assistance under the ACA would now receive tax credits/breaks.
> Insurance companies can’t cut you off for having pre-existing conditions (unless your state moves forward with a waiver program discussed below in which case you could be charged more for the effects of these conditions). However, if you lapse more than 63 days, insurers can charge up to 30 percent more on your premium.
This consistency requirement could hurt those who are facing continually high healthcare costs (often the case for those with pre-existing conditions who need continual medicines/care) combined with other rising living costs.
In other words, it’s not unreasonable to think that many people would choose relief from piling up bills in the short-run over long-term health coverage. Or, that those that are younger and healthier, may opt out completely, choosing to forego the cost now and roll the dice that they won’t need insurance. Early in my career (but over the age of 26), this was definitely a cost that I couldn’t afford so I went without.
> With the ACA, an estimated 10 million individuals with an annual income less than $15,800 were enrolled under the Medicaid expansion program and are now able to receive access to affordable healthcare.
Under Trumpcare, Medicaid moves from a matching program (federal funding matches state funding) to a capped subsidy (states get a certain amount per enrollee every year). The estimated impact is a $370 billion cut to federal funding to Medicaid over 10 years. The idea is the States would make it up, but with tight budgets, this isn’t likely to happen. There are also implications on cuts to programs for the elderly and the disabled who disproportionately served those on Medicaid.
This change also effectively halts enrollment, and discounts those that may need to come back on as their income changes. Also, as Senator Kaisch has pointed out,
“Many of those on Medicaid are dealing with mental illness, drug addiction, or chronic disease and require regular doctor visits. They shouldn’t be cycled off Medicaid overnight and give a few thousand dollars in credits to get health care.”
Additionally, the AHCA won’t allow Medicaid from being used at Planned Parenthood because it bans federal funding from going to organizations that provide abortions, even though PP doesn’t use federal funding for abortions. Normally, Medicaid reimburses Planned Parenthood after they treat Medicaid patients.
So, Medicaid patients would no longer be able to go to Planned Parenthood for even preventative care, despite the fact that this is the exact demographic PP is targeted to serve.
> Individual states would be able to apply for a waiver that lets them opt out of requiring insurers to follow important ACA regulations and consumer protection mandates. Thus, in doing so, insurers could offer a wider variety of plans but perhaps also less-comprehensive. In general, this hurts those with greater healthcare needs and benefits those who are healthier.
States could apply to waive under the proposal:
1) Essential Health Benefits (this is “a basic set of benefits, including hospital care, prescription drugs and maternity care, that must be included in all health insurance”): States could waive the benefit rules and establish their own standards. In particular, this could threaten what is considered quality women’s healthcare.
2) Community Rating (this is prevents health insurers from charging higher prices to customers with pre-existing health conditions): States could waive this and charge higher prices to sick customers who had experienced a lapse in insurance coverage of more than 63 days.
States that waive this rule would have to have another program to help people with high healthcare costs buy insurance through a separate pool. The AHCA gives the states funding to help subside the cost of doing so. In States that do so, insurance could become pricier for those with serious illnesses or even with a history of minor health problems while making it cheaper for those that are healthier.
This is also where all the concern of pre-existing conditions has come in. If states waive the regulation, insurers could charge more for many of the effects of pre-existing conditions (read H.I.V. and trauma resulting from rape). While they cannot deny coverage outright, the increased cost of these services could again make them inaccessible to those that need them most.
3) Age Rating: These are the “rules about how much more insurance companies can charge older customers than younger ones.” Under the ACA, insurers can charge their oldest customers no more than three times the price they charge their youngest ones. The new bill will increase this to five times, but states could waive that rule and establish a higher ratio under the amendment.
All this waiver talk largely puts healthcare in the hands of the States. This is a slippery slope because States that are more fiscally conservative and largely value cutting taxes above all else will likely under-spend for those that have higher needs but can’t pay for it.
The resounding message continues to be that affordability is not linked to accessibility, but that’s simply not the case. For the sickest, the AHCA would increase the cost of healthcare to the point where it is no longer accessible because it is no longer affordable.
The consequences are life-threatening.
Recommended recs
https://www.wsj.com/articles/republicans-defend-health-bill-on-sunday-morning-talk-shows
https://www.wsj.com/articles/medical-insurers-signal-big-shifts-in-state-coverage-plans-1493899453
https://mobile.nytimes.com/2017/05/05/us/politics/pre-existing-conditions-health-care.html
https://www.bustle.com/p/how-the-ahca-obliterates-planned-parenthoods-funding-55735
https://www.vox.com/2017/3/7/14844446/standard-poors-sp-ahca-obamacare-repeal-replace
