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There’s a lot of confusion about the new Republican health care plan, simply because they’re refusing to release it. In the US House, they kept it secret until literally the last-minute — they didn’t even give the Congressional Budget Office a chance to look at the cost or effect of the bill before voting on it.
And in the US Senate, they’re now planning a vote on their version of the bill next week, even though no one has seen it, CBO hasn’t reviewed it, there have been no hearings for experts to weigh in — nothing.
It’s a lousy way to pass legislation that will affect the health insurance of nearly everyone in this country. And it’s even lousier because we already know from the US House version, and leaks of the US Senate’s, that Republicans are crafting a bill that is popular with only 17% of the American public. Why? Because they gut protections for pre-existing conditions, and will bring back annual and lifetime caps on coverage. Let me explain.
Pre-existing Conditions
In the old days, insurance companies could deny covering you for the simplest of things. Allergies, eczema, high blood pressure, high cholesterol — all reasons to deny you insurance. And forget about serious illnesses like cancer. And if they did give you coverage, they would exclude your “pre-existing condition” from coverage for a period of time, or even permanently. So you’d technically have insurance, but it wouldn’t cover, say, your bum leg.
Then there’s women. In the pre-Obamacare days, insurers could and would charge women more for the same policies they sold men at a cheaper price. Why? Because women are just so pesky expensive with their lady parts. What’s more, many insurance policies wouldn’t cover pregnancy unless you bought a more expensive rider, and even then you had to wait a few months to get pregnant after you got the policy, or they still wouldn’t cover you.
And if you ever had a c-section, they’d refuse to cover any other pregnancies.
That was life before the Affordable Care Act (aka Obamacare). Now, because of President Obama and the ACA, insurance companies can no longer refuse to sell you a policy, nor can they set the price based on your current health (or pre-existing conditions). They have to cover you, and have to charge you what they charge everyone else your age in your region.
The Republican Pre-existing Condition Plan
Republicans claim they’re still protecting pre-existing conditions by not permitting insurers to turn you down for having an existing illness. But, they’re no longer going to require insurers to charge you the same for a policy that they charge everyone else your age. So you’ll be thrown into an insurance ghetto with other “sick” people, where they can offer you really bad policies for exorbitant prices. You could be charged three or five times what you pay right now for a monthly premium, and the policy will likely offer you less coverage than now. And if you can’t afford to pay for it, you die.
The Republican Annual & Lifetime Cap Plan
The second way Republicans sock it to people with pre-existing conditions is by bring back annual and lifetime caps. Under Obamacare, every plan has annual limits on what insurers can charge you. Meaning, in any one year, once you spend $2,000 or say $6,000 (depending on your plan) on copays, your insurance will pay 100% of your essential medical treatments (or benefits) for the rest of the year. That’s great news for people with more serious and expensive illnesses. Well, that’s going to go away with the Republican plan.
The Republicans have found a crafty way to let states opt out of the annual limit protections. It’s a bit complicated, but in a nutshell, Obamacare requires insurers to cover 10 “essential benefits,” like prescription drugs, maternity, and emergency care. The Republicans are going to let states opt out of Obamacare’s “essential benefits” guarantees. That means, states could decide that prescription drugs or maternity are no longer “essential,” and therefore they won’t be counted in your annual cap. So if you have a $2,000 annual cap, and your prescriptions cost you $4,000 a year, they will no longer count towards your cap beyond which you pay nothing for that year.
It also means that if the benefits aren’t “essential,” insurance companies don’t have to offer them at all. You’d instead buy expensive riders, to get “extra” insurance, just like the old days. Here’s how much those riders could cost under the Republican plan:
GOP to Gut Annual & Lifetime Limits too
Oh but there’s worse news. Essential benefits are also relevant for annual and lifetime limits on coverage. In the pre-Obamacare days, a lot of plans, whether you realized it or not, capped your lifetime coverage at $1 million to $2 million dollars. Once your plan payed out that much in benefits, you lost your insurance for the rest of your life. Insurers also had annual caps on benefits — for example, my pre-ACA plan only paid $1,200 per year in subscription drug benefits. Anything more I paid out of pocket, 100%.
People with cancer were typically the first to max out their coverage. After a few years of chemo, and some serious surgery, and they lost their insurance. Just imagine.
Under the Obamacare, anything that is considered an “essential benefit” can’t have an annual or lifetime limit on benefits. But, under the GOP plan, they’re going to let states opt out of these limits, so Alabama can decide that it no longer wants to consider maternity or prescription drugs or even cancer part of an essential benefit. That means the state can decide to let the insurance companies: a) no longer put a $2,000 to $6,000 limit on what you have to pay for your annual treatments, and b) the state can let the insurance company reimpose annual and lifetime limits on how much in benefits they’ll pay out for those conditions.
And this applies to everybody. Not just people who work for themselves. Not just the poor. If you get insurance through your job, these Obamacare annual and lifetime limit protections, and protections for pre-existing conditions, protect you.
And under the Republican plan being voted on next week in the US Senate, in secret, it won’t.
People Over 50 Will See Premiums Soar
The other neat little trick the Republicans are doing is changing the law to permit insurers to raise premiums on Americans between the ages of 50 and 64 (at 65 you get Medicare). Under Obamacare, insurers can charge people age 50-64 a maximum of three times what they charge the youngest people they insure. Under the House bill, insurers can charge older Americans five times what they charge younger people. That’s a 67% increase in premiums. That’s huge. And it doesn’t take into account the increased premiums for pre-existing conditions. This is just your “you’re old” tax.
And why is the GOP doing all of this? Because they need the Obamacare money to give a tax cut to the rich.
What you can do?
Get angry. I worked as a lawyer in the US Senate for five years. Nice gets you nowhere with a member of Congress. Their entire existence is driven by fear of their next election. You have every right to be pissed about what the Republicans are doing, and you should be. Call your US Senators and tell them you are mad as hell, and you expect them to kill the Obamacare repeal bill, also called the American Health Care Act (AHCA) by the House Republicans. In particular:
Tell Democrats: Shut it all down. If Republicans are going to try to pass legislation that that could risk all of our lives, and is only supported by 17% of the American people, while refusing to hold hearings — then shut it all down.
Tell Republicans: You are mad as hell, and you will do everything in your power to make them lose next election if they don’t stop trying to repeal Obamacare. If you have a personal health care story, feel free to share it. But remember, they only care if you’re angry. And you should be livid.
(See my earlier article on this topic.)
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