The New American Health Care Act Insurance Q & A

The American Health Care Act was passed by Congress on Thursday afternoon by a narrow majority.
Here are some answers to questions on what this legislation could mean for consumers.

How does it effect me today?

It doesn’t. We are now in Obamacare full force. No change yet- I don’t think for another couple of months (I HOPE) and even then- nothing will go in to effect until the following year so all insurance companies are now already filing their rates or have files for 2018 and all insurance companies have already decided if they will or will not stay on the exchange. Therefore most of 2018 should be covered by the ACA.What happens next?

If you will remember Schoolhouse Rock’s, “I’m Just a Bill,” It still has a ways to go and could go through changes. The bill will go to the Senate, where a special procedure known as reconciliation is being used so the bill needs only a simple majority of 51 votes to pass. There are 52 Republicans in the Senate, so if there are GOP defections, Vice President Pence may be needed to break a tie, assuming all Democrats vote no on the bill. Reconciliation rules also mean, however, that some provisions in the House bill might have to be taken out to meet Senate requirements. If that happens, the House would have to approve the new Senate version. If that is successful, the bill goes to President Trump, who is expected to sign it into law.

Would this bill repeal the Affordable Care Act?

Only partially. The bill is a first-stage effort that is supposed to address only the parts of the ACA that impact the budget. This is in order to avoid the need for a filibuster-proof, 60-vote majority in the Senate. But, it still has very wide implications, hitting on just about all of the health insurance system.

I have insurance through my employer. How could the bill affect me?

Your state has the option to seek a waiver of the 10, “essential health benefits,” required under the ACA. If your state chooses to do this, your employer could choose a more limited plan than you have now. Also, the GOP bill allows people to put more money into Health Savings Accounts (HSAs) and to use the funds for over-the-counter medications without a prescription. This will give your employer more options to choose from and a lower premium and deductible- with more competition.

I am an employer how could it effect me?

It eliminates the employer mandate- which will help businesses with more then 50 employees hire more employees, and start offering competitive insurance to all their employees with lower premiums, and lower deductibles.
Until now, under the ACA, we have seen employers keeping their employee count down to under 50 employees and/or offering Minimum Essential benefits (which only include preventative care) to avoid the penalty.

I have a preexisting condition, and the ACA meant insurers had offer coverage to me that is no more expensive than others in the general insurance pool. What would the AHCA mean for me?

An amendment crafted by Rep. Tom MacArthur (R., N.J.) allows states to obtain a waiver so people with preexisting conditions can be charged higher premiums. They have also expanded on what a pre-existing condition is, so whether or not you are considered as having a pre-existing condition could change. Rep. Fred Upton (R., Mich.) led an effort to add $8 billion over five years to help these people pay for increased premiums and out-of-pocket costs. However, numerous medical and consumer advocacy groups say this won’t be enough to offset the true added expenses.

If someone has continuous coverage then they should always be covered for pre-existing conditions- as long as there is no gap of 63 days or more in their insurance (which is the way it used to be).

I get subsidies through the Affordable Care Act to pay for my individual health insurance policy. What happens to those?

This bill would reduce funding for subsidies that are provided to people covered through the insurance marketplaces. However, this bill should provide more affordable options with lower premium and deductibles to choose from, which will ultimately makeup for the lost subsidies.

Would this new plan get rid of the individual mandate to have health insurance?

It does eliminate the penalty for not having insurance, but it allows insurers to tack on a 30 %  surcharge to their rates for people who allow their coverage to lapse for at more than 63 days, in order to discourage people from skipping insurance until they get sick. This will keep premiums lower and include more young individuals on health insurance.

I recently qualified for Medicaid in New Jersey after the state expanded its program under the ACA. What happens to me?

The Congressional Budget Office has estimated that over the next decade, the GOP bill would cut $880 billion from the Medicaid program, which covers low-income Americans and helps pay for long-term care for seniors and the disabled. People in Pennsylvania, New Jersey, and other states that chose to expand their Medicaid programs would still be covered for the next few years, as long as they maintained continuous coverage.

How will this affect the next few years?

Starting in 2020, Medicaid would switch to a,“block grant,” funding system, meaning that each state would be given a certain amount per person each year, rather than the current system that increases funding as demand for care increases. Critics say the change, intended to contain government health-care spending, would harm Medicaid beneficiaries.

What about lifetime coverage limits?

The ACA banned insurers from imposing lifetime limits on what they pay to cover an individual. The AHCA plan maintains that policy, but some coverage caps could become possible in states that take the waiver for, “essential health benefits.”

I’m on Medicare. What happens to my coverage?

The AHCA plan does not mean big changes for Medicare, but it would kill the Medicare payroll surtax on high earners, cutting money for the hospital trust fund to keep it solvent longer, money that would need to be found elsewhere. Also, poor seniors who qualify for both Medicare and Medicaid could see effects from budget cuts in Medicaid.

Does the new plan help cut the deficit?

According to a CBO estimate issued in late March, the House GOP plan would cut the federal deficit by $150 billion between 2017 and 2026. But since the bill has changed since then, the CBO needs to update its estimate.

How many people would lose their insurance under this plan?

The CBO has not come out with an estimate yet. However no one will lose their plan because they can go and purchase one of the newer competitive options.

Remember that this is still only a bill and not a law. If it does become a law, we will not see the effects of it for over a year. Most people effected (if the wording doesn’t change) will be people who let their coverage lapse for more than 63 days. The reality is that it is very likely to go through many changes in the senate, as promises have already been made to, “water it down.” 
As the changes roll in, Cosmo Insurance will always keep you informed and we will be here to answer your questioned with unparalleled service. 

You can read the bill in full HERE.