The Nuts & Bolts of Potential Health Insurance Changes

It’s A Defining Moment for American Healthcare

There is a lot of information circulating about potential changes to the American Health Insurance industry. Here is a nuts and bolts break down of the potential changes.

Senate Majority Leader Mitch McConnell is targeting to have a revised Senate healthcare bill to the Congressional Budget Office (CBO) by June 30, 2017. The CBO would then have several weeks to evaluate the impact of the changes and provide a score. The score reveals the monetary aspects of the Senate’s legislation and predicts how many Americans would be left without insurance under the plan. Following the announcement of the score, the Senate is scheduled to vote on the bill before the August recess.

The Republicans control 52 seats in the Senate to the Democrats 48 seats. Three no-votes from Republican Senators would stop the bill. There are currently nine Republicans who oppose the bill in its current form. Capital Hill insiders are concerned there may not be enough time to get the necessary votes to pass the bill.

So, what happens if the Senate healthcare bill does not pass? Obamacare will remain intact, but not without problems.  Experts predict that insurance companies will continue to leave the marketplace especially in areas with high-risk populations. In addition, premiums for the 2018 market will most likely increase.  There is also uncertainty about what the Trump Administration will decide regarding funding of the Cost Reduction Sharing (CSR) payments given to the insurers. Blue Cross Blue Shield of North Carolina is already telling enrollees to prepare for up to a 20 percent increase if CSR payments are eliminated.

The month of July will certainly be a defining month in the lives all Americans. The three pillars of our healthcare system are acceptance, access and affordability, which could change with this historic vote.  Below is a comparison of the Affordable Care Act, House Bill and the Senate Bill.

Credit – Shots Healthcare News from NPR. (2017, June 22). Chart- Who Wins, Who Loses With Senate Healthcare Bill. Retrieved from http://www.npr.org/sections/health-shots/2017/06/22/533942041/who-wins-who-loses-with-senate-health-care-bill

 

People Under 26

AFFORDABLE CARE ACT (OBAMACARE)

Can get insurance through a parent’s plan or buy independently.

HOUSE BILL: AMERICAN HEALTH CARE ACT

Stays the same.

SENATE DRAFT: BETTER CARE RECONCILIATION ACT

Stays the same.

 

 Adults Under 65

AFFORDABLE CARE ACT (OBAMACARE)

Can buy insurance on health exchanges, with tax credits and subsidies if they meet income requirements up to 400 percent of poverty level. Cost of insurance is based on tobacco use and age, with the people nearing 65 paying no more than three times what the youngest pay. Premiums can’t cost more than 9.5 percent of income. Those with very low or no income qualify for Medicaid.

HOUSE BILL: AMERICAN HEALTH CARE ACT

Will see tax credits to pay premiums based on age, not income, and that max out at $4,000, much less than under the ACA. The oldest people under 65 can be charged five times more than the youngest, and maybe more depending on state rules. Medicaid cut after 2020.

SENATE DRAFT: BETTER CARE RECONCILIATION ACT

The CBO report says 22 million people would lose health insurance over the next 10 years, with people between 50-64 disproportionally impacted. The oldest people under 65 would pay five times more than younger people on the exchanges. Subsidies to help pay for insurance would be less and end at incomes of 350 percent of poverty level. Federal contributions to Medicaid start to decline in fiscal year 2020.

 

 Low-Income Nursing Home Residents

AFFORDABLE CARE ACT (OBAMACARE)

Skilled nursing care covered by Medicare up to 100 days. Medicaid is available based on income.

HOUSE BILL: AMERICAN HEALTH CARE ACT

Skilled nursing care covered by Medicare up to 100 days. Medicaid services could be cut as states see federal funding decline.

SENATE DRAFT: BETTER CARE RECONCILIATION ACT

Skilled nursing care covered by Medicare up to 100 days per illness. Medicaid coverage for nursing home services could be cut as federal payments to states decline.

 

People With Pre-Existing Medical Conditions

AFFORDABLE CARE ACT (OBAMACARE)

Coverage cannot be denied or cost more.

HOUSE BILL: AMERICAN HEALTH CARE ACT

States can get permission to let insurers charge more for some pre-existing conditions and to exclude some people altogether. States would have access to federal money to help those with expensive policies or conditions.

SENATE DRAFT: BETTER CARE RECONCILIATION ACT

Insurance companies would be required to accept all applicants regardless of health status. But the draft bill lets states ask permission to reduce required coverage, also called “essential health benefits,” which would give insurers some discretion over what they offer in their plans. That could result in “substantial increases” in costs for people who want those services, according to the CBO. If a particular benefit is no longer classified as essential, insurers could impose annual and/or lifetime limits on what they spend on patients for that benefit. And caps on the annual out-of-pocket costs for patients would no longer apply.

 

People Who Go To Planned Parenthood

AFFORDABLE CARE ACT (OBAMACARE)

Federal programs reimburse for most Planned Parenthood services.

HOUSE BILL: AMERICAN HEALTH CARE ACT

A one-year block will be placed on federal reimbursements for care provided by Planned Parenthood.

SENATE DRAFT: BETTER CARE RECONCILIATION ACT

A one-year block will be placed on federal reimbursements for care provided by Planned Parenthood. The CBO estimates 15 percent of women would lose access to family planning care, increasing birth rates and Medicaid spending for childbirth and children’s insurance. But those increases would be offset by Planned Parenthood cuts.

 

People With Disabilities

The majority of Medicaid dollars go to people with disabilities.

AFFORDABLE CARE ACT (OBAMACARE)

May qualify for Medicare and also Medicaid.

HOUSE BILL: AMERICAN HEALTH CARE ACT

Services covered by Medicaid could be cut as federal funding to states declines over time.

SENATE DRAFT: BETTER CARE RECONCILIATION ACT

Services covered by Medicaid could be cut as federal funding to states declines over time. The CBO report suggests that by 2026, Medicaid enrollment would fall by more than 15 million people.

 

People Who Use Mental Health Services

AFFORDABLE CARE ACT (OBAMACARE)

Covered by all plans under essential health benefits.

HOUSE BILL: AMERICAN HEALTH CARE ACT

Could lose coverage in states that get waivers from covering essential health benefits.

SENATE DRAFT: BETTER CARE RECONCILIATION ACT

States could request waivers to opt out of requiring essential health benefits. If a state opted out of coverage for mental health care, the CBO says insurance that includes mental health care coverage could become “extremely expensive.”

 

Working Poor On Medicaid

AFFORDABLE CARE ACT (OBAMACARE)

Thirty-one states and the District of Columbia offer expanded Medicaid coverage.

HOUSE BILL: AMERICAN HEALTH CARE ACT

Federal funding for Medicaid expansion phases out, potentially affecting millions of people who are currently enrolled under the expansion.

SENATE DRAFT: BETTER CARE RECONCILIATION ACT

Federal funding for Medicaid expansion phases out between 2021 and 2023. In addition, eight states would have a trigger clause — if the federal matching rate declines below the ACA-promised rates, the expansion goes away immediately in Arkansas, Illinois, Indiana, Michigan, Montana, New Hampshire, New Mexico, and Washington. Further reductions would start in 2025. In a separate provision, states could impose a work requirement on recipients. Most able-bodied adult Medicaid recipients already work.

 

The Wealthy

AFFORDABLE CARE ACT (OBAMACARE)

Pay extra taxes to support ACA.

HOUSE BILL: AMERICAN HEALTH CARE ACT

The bill would repeal ACA taxes on corporations and cut taxes for the wealthy by about $592 billion.

SENATE DRAFT: BETTER CARE RECONCILIATION ACT

Similar to the House bill; would repeal ACA taxes on corporations and the wealthy that pay for insurance subsidies. That would add up to about $563 billion in tax cuts over 10 years, according to the CBO.

I hope this helps inform you about what may be coming our way.

Submitted by: Amy Noel

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