How would you, John or Jane Q. Public -- a hard-working, income-earning, tax-paying, home-owning, middle class American with employer-sponsored health insurance -- be hurt by the repeal of Obamacare and its replacement with the new Republican plan? That is the most important question on many Americans' minds. We've heard countless arguments about how the Republican health care bill (often called "Trumpcare" or "RepubliCare") would hurt poor and old people. We've heard how 22 million people would lose their insurance and how Medicaid funding would be slashed. And many people frankly don't care about these things as much as they care about their own families. So let's discuss the various ways mostAmericans would be hurt by RepubliCare, having nothing to do with fairness or social justice:
Annual and lifetime coverage caps: Prior to Obamacare, policies would often have coverage caps that would let them stop paying if your care got too expensive. Obamacare outlawed the practice, not just for individual "marketplace" plans, but for all plans -- even those provided by your employer. RepubliCare would let states decide whether to seek waivers ("opt out") to allow insurers to put caps back in their policies. According to Congressional Budget Office (CBO) projections, it's about a coin flip as to whether your policies would be affected by these waivers. If you did end up with caps on your policy, and if you or a family member had some expensive illness that blew past a cap, you'd quickly go bankrupt.
Out of pocket limits: Unlike the coverage caps that once protected insurance companies, out-of-pocket limits protect consumers. Between the deductible, co-payments, co-insurance, nobody has to pay more than this limit. All further expenses are paid in full by the insurance company. Before Obamacare, these limits were not required in insurance policies, so you might keep spending on serious illnesses until you were broke. But Obamacare places a $7,150 limit on out-of-pocket expenses (and less if you have a low income). If you can afford that, you won't go bankrupt.
Premiums vs. medical costs (Medical Loss Ratio): Under Obamacare, large insurance companies are prohibited from taking more than 15% of your premium checks for administrative costs and profit. The rest must actually go towards medical care (for either you or someone else in your pool). If more than 15% is left over by the end of the year, they have to refund it to you. Before Obamacare, insurance companies charged higher premiums and took larger profits. RepubliCare would strip this protection away beginning 2019, so that insurance companies could charge us higher premiums again.
10 Essential Health Benefits (EHBs): Under Obamacare, all individual and small group insurance policies must meet certain minimum quality standards, including coverage for 10 categories of medical expenses, called EHBs. EHBs include everything you might feel an insurance policy should cover -- doctor's office visits, emergency services, hospitalization, maternity/newborn care,, mental health care and substance abuse treatment, lab work, prescription medications, rehabilitative services, preventive care, chronic disease management, and pediatric services. Although the EHBs aren't required for group policies offered by employers, anybody can get these benefits by buying a marketplace plan. Prior to Obamacare, there were usually no benefits requirements, and policies frequently had gaping holes in coverage. Most plans didn't cover maternity maternity/newborn services, and many didn't cover prescription medications either. Other benefits were severely limited, for instance 3 cancer treatments or 2 days in the hospital. It was easy to go bankrupt under those old policies. In fact personal bankruptcies have dropped by half since the implementation of Obamacare, mostly due to better health insurance protections.
Preexisting conditions: Under Obamacare, nobody can be turned down for insurance or charged more for it because of their health status. People on group policies have always had this protection, but Obamacare extends it to small group and individual policies sold through healthcare exchanges. We simply don't know whether this protection is on the chopping block. The House RepubliCare bill would let states opt out, so that insurers could charge higher premiums for sick people. The Senate bill does not allow this opt-out. Ultimately the House and Senate must agree for a bill to get passed. In all likelihood, the House will go along with the Senate, so insurers would not be able to charge more for preexisting conditions. However, states would be allowed to opt out of the EHBs under both plans. As a result, you might be able to buy a policy at a reasonable rate even if you had cancer, but your policy simply wouldn't cover cancer.
Employer Mandate: Under Obamacare, employers with more than 50 employees provide them insurance or pay penalties. Although many business provided health coverage prior to Obamacare, this benefit is far more commonplace now, expanding coverage considerably. RepubliCare would eliminate this requirement, so many people with employer-sponsored healthcare insurance would lose their coverage. Of course as businesses get leaner and meaner, going up against aggressive competition from countries like China, don't be surprised if even the big companies stop offering this expensive benefit under RepubliCare.
Medicaid: Yes, Medicaid! So you're not poor or disabled or elderly, and you're not on Medicaid. How could this possibly impact you? Well, unless you meet an untimely end, you're going to get old and feeble. You'll probably suffer from conditions like heart disease and cancer, which can very easily cost six figures to treat, and RepubliCare might leave you responsible for paying most of these costs out of pocket. You will also eventually need to quit work, so your income will drop. You may have Social Security, or you may not, depending on what happens to the program. And a third of us will eventually need long term care, usually in a nursing home. That's expensive. The point is that we will all have greater medical costs and less income, and most of us will burn through our life savings before we die. About 62% of nursing home residents are on Medicaid, and there's a good likelihood this lies in your future too. Medicaid is already a pretty lean program. When Republicans cut funding in half, both through RepubliCare and the president's proposed budget cuts, what would that do for your future? Chances are that it won't be pretty.
Stabilization of markets: One claim Republicans make about their plan is that it will stabilize insurance markets they say are failing under Obamacare, with premiums spiraling skyward and insurers pulling out of local marketplaces. However, this isn't really true. According to the Kaiser Family Foundation and S&P Credit Portal, Obamacare's marketplaces will stabilize if simply left alone. However, active interference from Republicans is creating chaos and uncertainty for insurers, who have little choice but to hike rates or pull out. According to the Congressional Budget Office (CBO), markets would be similarly stable under either Obamacare or RepubliCare, and both would experience similar difficulties in local markets -- the same ones we're seeing now. Many people are receptive to the Republicans' "doomsday" messaging because they know of people with rapidly spiraling premiums and insane deductibles. These extreme examples relate to grandfathered policies (renewed from 2014 and onward) that don't benefit from the consumer protections of Obamacare and have entered into their own "death spirals." Obamacare is not to blame.
RepubliCare would hurt the vast majority of Americans, by stripping away the numerous consumer protections of Obamacare. That is because RepubliCare isn't really a health care bill. It's a tax reform bill. Its only purpose is to repeal Obamacare taxes on people earning more than $200,000 per year and to clumsily patch up the mess left behind. Anyone not in that income bracket will lose, which is why only 17% approve the bill. Even so, our lawmakers are doing their level best to ram this bill through, on behalf of their wealthy contributors. They are facing a very vocal opposition, but apparently we have not been vocal enough. You need to speak up too. Every voice is important. Take action! Click here!