House Republicans’ newest version of the American Health Care Act gets rid of some of Obamacare’s most popular provisions and would make it even more difficult for the sickest and poorest Americans to pay their medical bills.
Rep. Tom MacArthur (R-NJ) announced a new amendment on Tuesday that would gut protections for people with pre-existing conditions. Although insurers wouldn’t be able to deny coverage to people with pre-existing conditions, states would have the option to sell plans without the essential health benefits under Obamacare and charge people with those conditions much higher premiums. This means some of the sickest Americans would be charged thousands of dollars more than they currently do under the Affordable Care Act (ACA).
With the addition of this amendment, states would have a lot more power over the essential health benefits in small and individual group markets, said Sarah Lueck, senior policy analyst on issues of health care reform for the Center for Budget and Policy Priorites.
“The changes to the bill that are being circulated would let states define essential health benefits and gives them pretty broad flexibility to decide what benefits have to be included in policies, what benefits can be left out of people’s plans in the individual and small group markets and also the details of how those benefits are covered, and which prescription drugs are in there,” Lueck said.
In many respects, this would bring people back to pre-ACA days. Lueck cited federal data that shows 62 percent of pre-ACA plans didn’t have maternity care and that benefits for mental health care, substance abuse treatment, and prescription drugs were often missing from the plans.
An analysis from the Center for American Progress found that under recent changes to Trumpcare, insurers would charge $17,320 more for premiums for pregnant individuals. People with metastatic cancer would be charged $142,650 more.
States having the option to waive essential health benefits “eviscerates the meaning” of out-of-pocket protections, which limit the amount of money you spend out of pocket on co-payments, deductibles, and other cost-sharing each year on all essential health benefits, Leuck said. If the cap for out-of-pocket spending for essential health benefits is $7,000, and someone needs maternity care but it’s no longer considered an essential health benefit, that person will have to pay for it themselves.
The amendment would also affect the ACA provision that says insurers aren’t allowed to include annual and lifetime dollar limits on the benefits you receive. That provision is tied to the definition of essential health benefits, so it would be redefined.
“If they’re suddenly redefined in a way that isn’t comprehensive anymore, then any benefits left out or any changes made would affect the protections of annual lifetime limits,” she said.
States have the ability to participate in health status underwriting if they receive a waiver. The practice of underwriting, by its very nature, limits access to health coverage for people with pre-existing conditions, even though the amendment’s text claims it will not. People who don’t have pre-existing conditions at first, but develop them later would also be hurt by the practice.
“This is a huge problem for people with preexisting conditions. Technically insurers can’t say you can’t have a plan if you have [a] preexisting condition, but if the insurer can charge you far more in your premium because of preexisting condition or other health status issues then you may well be facing unaffordable premium rates that in effect mean you don’t get health coverage,” Lueck said. “This is turning back the clock for people with preexisting health conditions.”
The Republican health care bill includes a Federal Invisible Risk Sharing Program, which establishes a $15 billion fund to pool together people with expensive health conditions. But it isn’t sufficient to make up for the problems Republicans created for themselves by getting rid of the individual mandate and gutting protections for people with pre-existing conditions, among other changes.
“Overall, what would happen under this legislation is you’re getting rid of the individual mandate, decimating the markets, and then using this stabilization fund to dig yourself out of that hole, but it doesn’t really get you very far,” Lueck said. “…The mandate and subsidies are important to having a stable individual market, so if you roll those back or weaken those, you have to do these terrible things like not give people benefits they’re currently getting or charging sick people hundreds or thousands of dollars more. The stability fund is supposed to put money back in to help the market out, but it is really to fix problems the bill itself created.”
The ultra-conservative Freedom Caucus announced its support for the latest version of the legislation on Wednesday. It’s unclear if moderates will support it, since this version of the bill creates even more barriers for people trying to access health care. Of the over two dozen moderate Republicans Politico reached out to, none said they had been moved by the latest negotiations.