The Republican-led House on Thursday narrowly passed a bill to repeal and replace significant parts of the Affordable Care Act (Obamacare), leaving millions of Americans facing the prospect of losing their health insurance.
Donald Trump’s planned replacement will allow insurers to charge older customers five times as much, ditches a requirement that companies with 50+ staff provide coverage for employees, and allows states to opt out of providing essential benefits like emergency care and cancer treatment. It also allows them to waive protection for people with pre-existing conditions.
At the same time it would scrap taxes for people with higher incomes, and for the insurance companies and prescription drug makers that operate in a multi-billion dollar industry.
For President Trump and his fellow wealthy Republican friends it was a legislative victory and it showed in their faces as they celebrated in the White House Rose Garden.
Trump said: “Make no mistake, this is a repeal”, adding Obamacare was “essentially dead”.
“Premiums will be coming down, deductibles will be coming down, but very importantly it’s a great plan.”
While Trump and friends celebrated, millions of Americans were coming to terms with what the bill would mean for them.
The nonpartisan Congressional Budget Office estimates that the Republican bill would result in 24 million fewer people having health insurance by 2026, compared to Obama’s 2010 statute.
The bill sets aside billions of dollars more to help people afford coverage, but experts say that money is unlikely to guarantee an affordable alternative for people now covered under a popular provision of the existing law that prevents insurers from rejecting them or charging higher rates based on their health.
What happens to those with pre-existing conditions under the Republican plan remains unknown.
Several people unsettled by the prospects expressed these concerns on social media.
- Ends tax penalties Obama’s law imposes on individuals who don’t purchase health insurance and on larger employers who don’t offer coverage to workers.
- Halts extra payments Washington sends states to expand Medicaid to additional poorer Americans, and forbids states that haven’t already expanded Medicaid to do so. Changes Medicaid from an open-ended program that covers beneficiaries’ costs to one that gives states fixed amounts of money annually.
- Erases Obama’s subsidies for people buying individual policies based mostly on consumers’ incomes and premium costs. Replaces them with tax credits that grow with age that must be used to defray premiums. The credits are refundable, which means they can go to people with little or no tax liability. Credits may not be used to buy policies that provide abortion coverage.
- Repeals Obama’s taxes on people with higher incomes and on insurance companies, prescription drug makers, some medical devices, expensive employer-provided insurance plans and tanning salons. Obama’s law has used the revenue to help pay for expanded coverage.
- Requires insurers to apply 30 percent surcharges to customers who’ve let coverage lapse for more than 63 days in the past year. This would include people with pre-existing medical conditions.
- Lets states get federal waivers allowing insurers to charge older customers higher premiums than younger ones by as much as they’d like. Obama’s law limits the difference to a 3-1 ratio.
- States can get waivers exempting insurers from providing consumers with required coverage of specified health services, including hospital and outpatient care, pregnancy and mental health treatment.
- States can get waivers from Obama’s prohibition against insurers charging higher premiums to people with pre-existing health problems, but only if the person has had a gap in insurance coverage. States could get those waivers if they have mechanisms like high-risk pools that are supposed to help cover people with serious, expensive-to-treat diseases. Critics say these pools are often under-funded and ineffective.
- Provides $8 billion over five years to help states finance their high-risk pools. This late addition, aimed at winning over votes, is on top of $130 billion over a decade in the bill for states to help people afford coverage.
- Retains Obama’s requirement that family policies cover grown children to age 26, and its prohibition against varying premiums because of a customer’s gender.
The Associated Press also spoke to people uncertain about the future of their healthcare.
FORMER UTAH CHEF
Jake Martinez said he’s worried about getting health insurance in the future because he has epilepsy, considered a pre-existing condition by insurers.
For the last several years, he, his wife and their three children have settled into a comfortable place using health insurance under the Affordable Care Act. But now the Murray, Utah, residents are worried about what may happen with this new health care bill.
“Today, it really kind of sunk in that not only are we not going to potentially have health care coverage but that it was done as a political win rather than a well-thought-out plan,” said Martinez, a 32-year-old former chef who’s studying social work. “That’s what stings about it.”
Shortly after being diagnosed with type I diabetes, Amanda Perkins learned about the perils of pre-existing conditions when she starting trying to buy health insurance.
Now she worries that protections under the Affordable Care Act that made sure certain essential health benefits, like insulin prescriptions, could be eliminated.
The new Republican plan would let some states allow insurers to charge higher premiums for people with pre-existing conditions, but only if those people had a lapse in insurance coverage. Supporters say those states would need to have programs in place to help people pay for expensive medical treatments, including high risk pools.
But Perkins said Kentucky’s previous high risk pool had a 12-month waiting period and was too expensive for her.
“I bought a house just a couple of months ago. Will it come down to me paying my mortgage payment or paying my health insurance so I don’t have a lapse in coverage?” said Perkins, an attorney for a small firm in Lexington, Kentucky.
KANSAS GRAPHIC DESIGNER
Janella Williams has a rare neurological disorder that forces her to receive expensive IV drugs every seven weeks. Without it, she would not be able to walk.
Williams, who owns her own graphic design company in Lawrence, Kansas, pays $480 under an Obamacare plan. It keeps her out-of-pocket maximum at $3,500 a year and provides her coverage despite her pre-existing condition.
“I’m terrified of becoming disabled. If I’m being completely honest, I’ve thought of ending my life if it comes to that,” she said.
High risk pools run by the state are not the answer, she says. The Republican plan would also bring back lifetime caps on coverage, which Williams says she would meet after only her first IV treatment. She and her husband both work full time, but wouldn’t be able to afford the roughly $600,000 a year her treatments cost once the cap is met.
“I have really lost my faith in humanity,” she said. “It’s terrible how little we care for the sick.”
NORTH CAROLINA FINANCIAL ADVISER
John Thompson credits his survival in large part because he bought a family insurance policy through the Affordable Care Act marketplace.
Thompson, of Greensboro, North Carolina, was laid off in 2013, lost his employer-backed insurance and diagnosed with cancer during the year he was unemployed.
If the House proposal allowing insurers to make coverage for pre-existing conditions unaffordable takes hold, he fears his cancer history will make him uninsurable if he would lose his current job as a retirement financial adviser.
“Like many of us here, whether you have asthma or a heart condition or diabetes or like me, cancer, any type of pre-existing condition, you go back to the way it was before, you give insurance companies carte blanche to do their underwriting and to exclude you,” Thompson said.
Shelby Jehlen, of New Port Richey, Florida, was diagnosed six years ago with leukemia and says she wouldn’t be able to afford insurance if she lost her roughly $400 a month subsidy.
Jehlen saves about $1,000 every three months to see her cancer doctor under her Obamacare plan, but still pays about $1,500 for the check-ups.
She was forced to quit work because of all the X-rays and other chemicals she was exposed to daily as a veterinary assistant and now cuts corners, sacrificing phones and school activities for her two teen daughters, to afford the monthly premiums. The stress has caused her to struggle with depression and anxiety.
“Absolutely, I’m scared. I’m worried I’m going to have to figure out what I’m going to do with all my side effects with my leukemia if they take this away from me,” she said.
Adrienne Standley has been preparing for the possibility of losing her insurance since President Donald Trump took office.
Three days after the inauguration, she set up an appointment for a birth control implant so she would be covered for four years, no matter what happens.
The 29-year-old operations director at a start-up apparel business in Philadelphia also has asthma and attention deficit disorder.
“I’m looking at stockpiling, making sure I have an inhaler,” she said. “I’m pretty scared to lose coverage.”
NEW ORLEANS ATTORNEY
John S. Williams says he’ll be forced to close his practice and find a job with a group insurance plan if he’s no longer covered under the government’s health care plan.
The New Orleans attorney has multiple sclerosis, a neurological disease for which medication alone costs $70,000 a year. He buys insurance for himself on the individual marketplace, and the Affordable Care Act has made that possible, he said.
“We always hear about job growth and business creation - being able to have affordable health care drives that,” Williams said. “Because of the ACA I am able to employ people and help the economy grow.”
The bill now passes to the Senate where its path will be at least as bumpy with little doubt the measure will change, assuming it survives.