If you’re a United States resident and don’t live under a rock, chance are the words health care and pre-existing conditions appeared in your news feeds more than a few times in the last week.
The American Health Care Act passed by a thin margin in the U.S. House of Representatives Thursday, and is now headed for a vote in the Senate. Cue the social media firestorm as both liberal and conservative news outlets (and their readers) published their own iterations of what the heck this meant.
If you’re like me, you want to know how you and your loved ones will be affected by major changes in health care policy. Figuring that out is harder than it sounds, however, because misinformation and sensationalism are coming from both sides of the aisle.
I waded through the muck to learn the real facts (and what they mean) so you don’t have to.
First, some key terms:
AHCA: The American Health Care Act, AKA the bill Republicans passed 217 to 213 in the House on Thursday. All references to the AHCA in this article refer to the HOUSE VERSION of the bill. It is possible the Senate will change or rewrite elements of the bill before voting.
ACA: The Affordable Care Act, AKA Obamacare, AKA the thing Republicans are trying to kill off ASAP.
Repeal and Replace: This bit of jargon has become something of a slogan for Republicans when they talk about their plans for Obamacare. The AHCA covers the “replace” part.
Pre-existing condition: An illness or condition that would label anyone who has it as a “higher risk” customer. Before the ACA, insurance companies were allowed to charge higher premiums (or deny coverage) for people with pre-existing conditions.
Will I be required to have insurance?
However, anyone who decides to forgo insurance should be really sure about it. If you let your insurance lapse more than 63 days, then decide you actually do want coverage, insurance companies will be allowed to charge you up to 30 percent more for a new policy.
Will my premium go up or down?
Depends. Republicans argue their bill will make health care premiums more affordable for the average consumer – and it might, but it really depends on how old you are and where you live.
The AHCA will allow insurance companies to charge older customers up to five times more than younger ones. (For context, the ACA capped insurance companies at charging older people no more than three times what they charge younger people).
“A 27-year-old who makes $30,000 a year would see costs rise about $2,000 in Nebraska but fall by about the same amount in Washington state. A 60-year-old, however, would see costs rise almost everywhere, with increases of almost $20,000 a year in Nebraska,” writes NPR.
Both the CBO (Congressional Budget Office) and the Kaiser Foundation say lower-income older people are most likely to be worse off under the AHCA.
Want to know how you’ll be affected specifically? The Kaiser Foundation published an interactive map to help people figure out how their age, income, and location will affect their coverage under the AHCA.
What about taxes?
The bill cuts essentially all of the taxes (about $592 billion worth) implemented by the ACA on higher-income people and businesses to pay for subsidies that helped lower-income people buy insurance. So, if you make more than $200,000 a year (or $250,000 per married couple per year), you’ll see a drop in taxes under this bill.
I’m under 26 and on my parents’ plan. Will I lose coverage?
You’re OK. The AHCA does not prevent young people under 26 from staying on a parent’s insurance plan.
OK, WTF is happening with pre-existing conditions?
You probably read an article or 12 over the weekend alleging that Republicans just voted to strip citizens with pre-existing conditions of their coverage. While the claim is rooted in some truths, this is a way-too-simplistic look at it.
Obamacare’s consumer protections require insurance companies to cover pre-existing conditions at no extra cost. It also prevents insurance companies from putting lifetime or annual limits on coverage.
The AHCA would hand power back to the states to decide if these policies stay in place.
The bill itself does not define what a pre-existing condition is, and it doesn’t give insurers the right to deny coverage outright to a customer. What it does do is let individual states opt out of those consumer protections.
If your state doesn’t apply for a waiver, the protections as you know them will stay the same.
If your state does apply for a waiver, insurance providers in your state won’t be required to provide “essential health benefits,” like mental health coverage, prescription drugs, and maternity care, and they’ll be able to charge more for coverage if you have pre-existing conditions.
States with waivers will probably offer a wider range of policy options, including lower-premium policies that have lifetime/annual coverage limits and exclude items on the “essential health benefits” list.
Proponents of the bill claim this will allow people more options to select plans within their budget. Critics worry the plans which include mental health coverage, maternity care, and prescription drugs will become too expensive for people who need them.
Will the bill really make rape a pre-existing condition?
Headlines claiming rape would qualify as a pre-existing condition, barring victims from health coverage, sparked massive outrage online. This claim needs context and clarification:
The bill does not explicitly define rape as a pre-existing condition. However, because it gives states the power to nix the ACA’s consumer protections, it is possible that companies could charge higher premiums for customers who experienced trauma, were injured, and/or contracted STIs from sexual assault.
States that receive a waiver to opt out of the ACA’s protections can resume the pre-ACA practice of using underwriters to determine a customer’s “medical risk.”
Insurance companies in states with waivers would be allowed to charge higher premiums “if they see that you’ve been screened for S.T.D.s, had treatment for an S.T.D., taken H.I.V.-preventive medication, had more than annual pelvic exams or had other follow-up encounters with the medical system,” Sabrina Corlette with Georgetown’s Health Policy Institute told The New York Times.
Because victims of sexual assault commonly seek out the above procedures, allowing underwriters to charge more for people who’ve had them does discriminate against rape survivors who live in waiver states. Critics worry this will make victims even less likely to report crimes against them.
I heard the bill would make domestic abuse a pre-existing condition, too. Is that true?
Many websites reported domestic violence would be considered a pre-existing condition under the AHCA. Again, headlines like these are jumping the gun.
Before the ACA, there were five states (Idaho, North Carolina, South Carolina, Vermont and Wyoming) which did not officially ban insurance companies from categorizing domestic violence as a pre-existing condition.
If the ACA goes bye-bye, the power to make these decisions goes back to the states, so there’s no way to know if individual states would allow insurance companies to deny (or charge more for) coverage to domestic abuse victims until after the bill goes into effect.
Will my insurance still cover birth control?
If your state doesn’t apply for a waiver, yes. If you live in a waiver state, your insurer won’t be required to cover contraception if the AHCA goes into effect. It will all depend on your state, insurer, and specific policy.
My insurance is through my employer. Am I affected by this?
Possibly. In waiver states, companies motivated to keep premiums down for their employees might pick plans that exclude “essential benefits” or have a lifetime or annual coverage limit. If the AHCA passes through the senate and goes into effect, you’ll want to communicate with your HR department about how your coverage might change.
I’m on Medicaid. Will I be affected by this?
Yes. The AHCA is rolling back Medicaid expansions that went into place under Obamacare. The expansions allowed single, non-disabled adults who are just above the poverty line to qualify for medicaid. Republicans want to undo these expansions by 2020, rescinding Medicaid for the people who signed up under Obamacare’s expansion –– about 10 million people.
Is the bill going to pass through the Senate?
We’ll have to wait and see. The bill still has to clear the Senate before it can become law, and many lawmakers believe it will be an uphill battle.
The bill needs 51 votes to pass in the Senate. It’s possible Senators will tear apart and re-write many aspects of the bill before that happens, so very little (read: nothing) is set in stone at this point.
The Washington Post has a very handy timeline to keep you up to date as things change.
What else do I need to know?
People will lose coverage, but not all at once. A CBO report claims 24 million people will cease to have health insurance over the course of 10 years. This includes people forced to drop their policies because they can no longer afford them, people who opt out because they think they don’t need it, and people who will no longer qualify for Medicaid.
Proponents of the bill point at the money this will save: That same CBO report claims the plan will reduce the U.S. deficit by $337 billion. Critics say we should be providing health coverage to our most vulnerable.
What can I do now?
If you agree with the AHCA, call your rep. If you disagree, call your rep. If you agree with some parts but not others, call your rep. We know from our last ACA article that actually picking up the phone to call your U.S. representative is more effective than reaching out via email or social media. It’s easier than you think –– just look up your rep here and pick up the phone.
What other questions do you have about the Affordable Care Act? Start a discussion in the comments!
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