The Trump administration’s healthcare bill, the American Health Care Act (AHCA), passed the House on May 4th by a slim margin. It has been seen as likely to pass the Senate, with some changes expected to soften the more unpopular provisions in the legislation.
However, new concerns have recently arisen that the bill was not in compliance with budget rules, meaning the House may be required to hold a repeat vote. This is because the bill contains two major amendments, the financial impact of which have not been assessed by the Congressional Budget Office as required. As of this writing, the bill still has not been sent to the Senate for consideration according to Business Insider.
Some Republicans stated they had been hoping to get the bill finalized before the July 4th recess, but the delay of the bill’s transfer to the Senate may make completion by this deadline impossible. Some of the bill’s supporters are also concerned about loss of focus as recent newsworthy White House events have taken over the media spotlight.
The AHCA as written is expected to have a sweeping impact on cost of healthcare for a large number of Americans according to a recent study by the Kaiser Family Foundation (KFF). According to Modern Healthcare the Congressional Budget Office initially projected that the bill as passed by the House would reduce the number of insured Americans by 24 million and could weaken protections for millions of people with pre-existing medical conditions.
Here is a breakdown of some of the possible implications for those with pre-existing conditions, those with chronic illnesses, and seniors.
For individuals with pre-existing conditions or chronic illness
Some of the main complaints from insurers and citizens against the first version of the bill was a lack of protection for individuals with pre-existing conditions. These individuals could be refused coverage by insurance companies depending on state policy. Insurers may increase premiums to offset costs of covering more expensive enrollees, as a results of government subsidies being reduced. The 9 million “dual-eligible” members who are enrolled in Medicare and Medicaid would be the hardest hit by the AHCA legislation as currently written, due to Medicaid cuts
To alleviate these concerns, Republicans have proposed an addendum which would set aside $8 billion to supplement high risk member pools. However, many are saying that this amount won’t be nearly enough, and that decent coverage would become unaffordable for many members in the pools.
Several doctors’ associations, including the American Medical Association and the American Academy of Family Physicians, have criticized the lack of protections. They warn that the high risk pools would offer “second-class” coverage to people with pre-existing conditions, according to Forbes.
Examples of pre-existing conditions
The list of pre-existing conditions is also getting lots of press. According to Time Magazine, “The American Health Care Act stipulates that states can allow insurers to charge people with pre-existing conditions more for health insurance (which is banned under the ACA) if the states meet certain conditions, such as setting up high-risk insurance pools.”
According to Business Insider: “An estimated 27% of Americans under 65 have health conditions that could leave them uninsurable, according to the Kaiser Family Foundation. Some of the preexisting conditions that insurers declined coverage to before the ACA… included diseases such as diabetes and heart disease, which affects millions of Americans.” Below are some health issues that were labeled pre-existing conditions by several large health insurers prior to Obamacare.
Preexisting conditions that did not qualify for coverage: AIDS/HIV, lupus, alcohol abuse/Drug abuse with recent treatment, Severe mental disorders such as bipolar disorder or an eating disorder, Alzheimer’s/dementia, Multiple sclerosis, Rheumatoid arthritis, fibromyalgia, and other inflammatory joint disease, Muscular dystrophy, cancer, severe obesity, cerebral palsy, organ transplant, congestive heart failure, paraplegia, coronary artery/heart disease, bypass surgery, paralysis, Crohn’s disease/ ulcerative colitis, Parkinson’s disease, chronic obstructive pulmonary disease /emphysema, pending surgery or hospitalization, diabetes mellitus, pneumocystic pneumonia, epilepsy, pregnancy or expectant parent, hemophilia, sleep apnea, hepatitis C, stroke, kidney disease, renal failure, transsexualism.
Other conditions that could make it harder to purchase a health insurance plan: Acne, allergies, anxiety, asthma, basal cell skin cancer (a type of skin cancer that doesn’t tend to spread), depression, ear infections, fractures, high cholesterol, hypertension, incontinence, joint injuries, kidney stones, menstrual irregularities, migraine headaches, overweight, restless leg syndrome, tonsillitis, urinary tract infections, varicose veins, and vertigo.
For Seniors
The AHCA has drawn opposition from many senior advocacy groups, including the AARP, National Committee to Preserve Social Security and Medicare, the Senior Citizens League, the National Council on Aging, and Justice in Aging. Many of the organizations claim it will negatively impact older adults with higher premiums and reduced coverage.
Here is an excerpt from a letter to House representatives from the AARP Executive Vice President and Chief Advocacy and Engagement Officer Nancy A. LeaMond: “Throughout consideration of the AHCA, we have been expressing serious concerns about the impact that this legislation will have on older Americans. The Congressional Budget Office (CBO)’s last estimate further demonstrates the harmful impact of this bill on older Americans and some of our most vulnerable. Specifically, the American Health Care Act will weaken the fiscal sustainability of Medicare; dramatically increase premium and out-of-pocket costs for 50-64 year olds purchasing coverage on the individual insurance market; allow insurance companies to once again discriminate against those with pre-existing conditions; substantially increase the number of Americans without insurance; and put at risk millions of children and adults with disabilities and poor seniors who depend on the Medicaid program to access long-term services and supports and other benefits.”
The Atlantic broke down the statistics of support and opposition for the AHCA among seniors in a recent article. One of the main findings was that House Republicans who were on the fence prior to passing the AHCA bill represented populations that were older on average: “An Atlantic analysis shows that House Republicans who have expressed opposition to the GOP’s replacement plan are heavily concentrated in districts where the median age, the number of seniors, or both exceed the national average.”
According to National Public Radio (NPR):
State waivers
This section of the bill essentially amounts to an optional, state-level full repeal of Obamacare. It would give states the ability to apply for a waiver that lets them opt out of most of the regulations and consumer protections that were included in the Affordable Care Act.
States could apply for waivers that would allow insurance companies in their states to do three things: 1. Charge older people more than five times what they charge young people for the same policy; 2. Eliminate required coverage, called essential health benefits, including maternity care, mental health and prescription drugs, that were required under the Affordable Care Act; and 3. Charge more for or deny coverage to people who have pre-existing health conditions, such as cancer, diabetes or arthritis.
The waivers could also impact people with employer-based insurance, because insurers could offer policies that have annual and lifetime benefit limits, which are banned under the Affordable Care Act, and some companies may choose those policies for their workers to lower premiums.
States that get waivers would very likely see insurance companies offer many more policy options, some with fewer benefits and lower premiums.
Those states would be required under the law to create some other way to ensure that people with expensive illnesses are able to get health care, and the law provides up to $138 billion over 10 years for such programs, typically called high-risk pools.
However, an analysis released Thursday by consulting firm Avalere Health concludes that that amount would be inadequate for providing full health coverage for the number of people who now buy insurance in the individual market and have medical problems.
