WHITE HOUSE CELEBRATION FOR PASSING THE HEALTH BILL WAS VERY PRE-MATURE

…The pre-mature White House celebration for the House passing the AHCA

 

A pre-mature White House celebration for passing the AHCA is so appropriate for the Trump administration.

 

Do you remember the following from our braggart president about his “phantom health care plan”:

 

According to Trump’s promises: “Everyone will have health care insurance.”  “It will coast much less!”  “It will be a better plan!”  “All pre-existing conditions will be covered!”  “It will be a beautiful plan!” 

 

If the current bill passed by the Republicans were to remain as is, here is the what it would mean for those Americans now on Obamacare:

 

·       24 million people that now have insurance will be dropped.

 

·       Premiums will continue to rise, especially for the poor, the elderly and the very sick.

 

·       For those that need it most, insurance will not be there, and if it is, it will cost much, much more.

 

·       Not everyone with pre-existing medical conditions will be covered.

 

·       The only thing that is better is that, there may be more insurers to choose from, but that’s no guarantee.

 

As to the cost of the latest bill, Republican lawmakers have passed the latest bill without an assessment by the nonpartisan Congressional Budget Office (CBO).

 

The AARP, National Nurses Association, the National Medical Association, AMA, and the AHA are all against the bill passed by the House Republicans.

 

First, let’s get the actual name of the newly passed House bill.  It is the American Health Care Act (AHCA) as the House Republican’s replacement for the Affordable Care Act (ACA) or “Obamacare”.  The AHCA includes a continuous coverage provision that boosted insurance rates by 30% for one year if he or she has a lapse in their health care coverage.

 

As part of an effort to attract more Republican House votes, Republicans have added an amendment, crafted by Rep. Tom McArthur (R-NJ), that allows states to seek individual waivers from the new law.

 

One possible waiver would replace the continuous coverage provision so that insurance companies for one year could consider a person’s health status when writing policies for the individual and small group plan markets. (In other words, if someone has a pre-existing condition, the insurance company could decide to charge them a higher premium.) 

 

Another possible waiver would allow the state to replace the federal benefits package with a smaller package of benefits, again limited to the individual and small-group markets.  (In legalese, that means the company could limit a person’s coverage, solely based on a person’s poor health.)  Sounding familiar to American insurance before the ACA?

 

The theory is that removing these sicker people from the markets and allowing policies with skimpier options would result in lower overall premiums.  DUH!

 

Then, for a period of one year, a person who fell into this category would face insurance rates that could be based on their individual condition. But those states that seek these waivers are required to operate a risk program or to participate in what is called an invisible risk sharing program.  As expected, these programs would be more expensive.

 

Alaska has such a program that helps cover the bills for one of 33 medical conditions (such as HIV/AIDS or metastatic cancer). The individual with the condition submits their medical bills to the insurance company, which then bills the state. But the insurance company does not consider the cost of this care as part of its calculation for premiums to the other individuals in the state.  (That's good.)

 

All told, the AHCA would allot $138 billion over 10 years for a variety of funds that would seek to keep premiums lower or to assist with cost-sharing. $8 billion over five years was added to the pot to woo those wavering Republican lawmakers, (w/o this $8 Billion, the bill would never have passed, but$8 billion is only a drop in the bucket for what’s actually needed.)  The idea is that these additional funds could be used for so-called high-risk pools. But many states have had such pools to help people with preexisting conditions before the ACA. But the current proposal does not require a state with a waiver to set up such a pool. What those Americans are supposed to do….no one knows.

 

Therefore, you might live in a smaller population state like Wyoming or Nebraska and if you have a pre-existing condition, you might be S.O.L. for getting any health care coverage.

 

Remember…..24 million Americans will be losing their coverage under the new Republican’s AHCA plan.

 

Persons generally would not be affected unless they lived in a state that sought a waiver. Moreover, they would need to have a lapse in health coverage for longer than 63 days and they would need to have a pre-existing condition. Finally, they would have to be purchasing insurance in the individual market, i.e., the health exchanges that currently serve about 18 million Americans.

 

What is really confusing is that even though those who get their insurance from their employer, and that’s 155 million Americans, presumably they would not be affected.  However, the Congressional Budget Office (CBO) has projected that under the initial version of the AHCA, 7 million fewer people would be covered by employers than under current law by 2026.  That projection hasn’t changed.

 

The AHCA eliminates cost sharing and offers a smaller tax credit to defray premium costs.  This will result in higher overall health costs that may make insurance unaffordable for many people. (The CBO projected that the 24 million people would be without health insurance by the year 2026.)  Depending on the approach taken by a state, some people might find it difficult to keep up their coverage for a full year before they qualify for lower prices at the community rate.

 

A big question is whether the funding to cover these folks is adequate. High-risk pools were big money losers and underfunded in the pre-Obamacare days, even though many had restrictions, high premiums and long waiting lists. A $5 billion federal pool, established by the ACA as a bridge to the creation of the exchanges in 2013, covered about 100,000 people, but it was eventually suspended when it ran out of money.  (The same is expected for the AHCA.)

The Center for American Progress, a group that opposes the AHCA, produced an analysis that indicated that with the additional $8 billion, the maximum enrollment the AHCA’s funds would cover is about 700,000 people. If just 5% of the people currently in the individual market ended up in high-risk pools, and all the states sought a waiver, that would immediately overwhelm the proposed funding.

 

When it comes to health care, all Americans should be wary about claims that important changes in health-care coverage are without consequences and that people are “protected”..

 

There are always winners and losers in a bill of this size. In this case, if this bill ever became law, much would depend on unknown policy decisions by individual states.  Then it would be about how those decisions are implemented.

 

This Republican House bill will never become law in its current state, many US Senators have already made that statement.  So the celebration at the White House after it passed the House was very pre-mature and totally out-of-line.

 

But it was totally in-line with how the Trump administration does their business.

 

Copyright G.Ater  2017