Does AHCA Turn the Clock Back to Pre-Obamacare and Little More?

Had a chance to examine the “Republican American Health Care Act” or AHCA, as it’s now known? Only the American government can put together a series of words that are as fascinating as they are incredulous. I’ve written several pieces today to cover the House approval of the new healthcare bill and you can be sure there remains some uncertainty with future obstacles as it moves through the American legislative process.

Here are a few of the bigger points – and again, there are still a lot of opportunities for our elected officials to bleed over the Act with their demands. This is not a complete look at the bill – not by a long shot, but it does address the key concerns everyone’s talking about.

First, one of the big changes is that you are no longer required to have insurance and you won’t take a hit on your taxes each year. Tax credits are redressed, too, if you do have coverage.

Guaranteed coverage for pre-existing conditions is still built in, but there are a few elements that define that aspect of the rule. For instance, an insurance company can’t charge you more for a pre-existing illness, at least not directly. There are three specific waivers that are really the “meat and potatoes” of this bill and they speak to the pre-existing conditions confusion.

The big fact: your state can apply for any or all of these waivers. To get a better idea of what your state might or might not do, take a look at the current breakdown here.  You can see, in detail, what’s referred to as the Essential Health Benefits Benchmarks by state. It might give you some insight as to what to expect. Here in Mississippi, you can bet our governor has a far different take on the waivers than what the governors of California or New York might have.

Under Obamacare, or ACA, an insurance company could not refuse to issue a policy because of one’s health status. That requirement remains in the overhaul (or whatever Team Trump is calling it). Here’s where your state’s position becomes important:

  1. One waiver focuses on the applicant’s age and how much an insurance company can charge. As it is now, an insurance company can charge older policy holders up to three times more than what they offer younger policy holders. The new rules allow an insurer to increase that difference to five times – with a door left open for even more increases in the coming years.
  2. You may remember the huge debate surrounding required coverage with Obamacare. Insurance companies were bound to cover outpatient services, emergency medical services, hospital stays, pregnancy, pediatric care, substance abuse programs, mental health services, prescription drug coverage, lab services and a few other services. Birth control and “breastfeeding coverage” was also required, though I’m not entirely sure what kind of health coverage a breastfeeding mother would require. There was some controversy with a few of the covered services.

Your state’s leaders will now define the parameters as they are tasked with the responsibility of determining what essential benefits residents will have access to as part of their insurance coverage. I don’t know how each state views coverage for certain illnesses, but I do know that Florida has had one hell of a time dealing with the opioid drug crisis. Many of that state’s leaders are blind to the problem. These are the kinds of challenges that will have to be addressed – there are lives at stake and nothing will ever change that, no matter how many times you change the name of the law.

  1. Insurers will be able to raise their premiums if a person drops his coverage for any reason. If you drop coverage and don’t re-enroll within 63 days, you’ll likely get hit with a higher premium – and the insurer is free to increase it considerably. Here’s the problem with that:

In 2015, the Kaiser Family Foundation released a report, “Medical Debt Among People with Health Insurance”. (On a side note – the information presented is a perfect snapshot of the common challenges with healthcare in this country.) As part of the report, 23 people from all walks of life and with varying income and family dynamics were selected.

The goal was to find out how medical debt affects families, especially if they have healthcare coverage. Of the 23 people, 18 said they have had an illness that triggered an income loss. All said they experienced damaged credit ratings as a result of those illnesses. It didn’t need to be a financially catastrophic illness, either. All agreed that “much smaller amounts proved unaffordable”.

Of course, major health events triggered big problems, and for the “vast majority of those interviewed, the medical event associated with the debt also left the patient unable to work or prompted a working family member to quit or reduce hours in order to become a caregiver.”

Take one guess as to what happens next.

They can no longer afford to cover their insurance premiums.

They can re-enroll later, but if it’s outside the 63 day window, they face a punishment penalty for dropping coverage and now, there likely exists a pre-existing condition that the insurer is free to price into the policy.

So, what does all of this mean? Best I can tell, we go back to a pre-Obama healthcare world. That’s not a bad thing entirely, but there were some much-needed protections that were a part of Obamacare. It’s a tradeoff, but whether or not it’s worth it is something each person will have to determine for himself. Here’s an interactive Kaiser map where you can enter your state, age and a few other details and get a better idea of what to expect.

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