Amended American Health Care Act Passes the House of Representatives
Editor's Note: Living Beyond Breast Cancer is part of a coalition of 25 advocacy groups opposing the AHCA because of its optional provisions for states. To voice your opinion to Congress, call or write your senator.
The House of Representatives has passed the American Health Care Act, the Republican replacement for the ACA that could change how the government regulates health coverage across the country. The bill will next go to the Senate where debate will continue and further changes to the bill could be made. The ACA is still the law and will continue until the Senate passes the bill, if it does, and the president signs it.
The American Health Care Act, or AHCA, was first introduced in March but never went to vote in the House of Representatives. After the vote was cancelled, changes were made to the bill to attract more Republican votes. Those changes to the bill would make patient protections weaker. The “McArthur Amendment,” for example, lets states choose not to require insurance providers to cover essential health benefits. It also allows companies to charge people with pre-existing conditions, like breast cancer, higher prices.
Republican members of the House of Representatives proposed the AHCA as a replacement for the Patient Protection and Affordable Care Act, also known as the ACA and Obamacare. The AHCA includes parts that would change financial assistance for buying insurance and allow companies to charge older people up to 5 times the amount they charge younger people for the same plan.
The AHCA would also change how Medicaid is funded, ending the expansion of coverage provided in the ACA and limiting how much the federal government gives states for people on Medicaid. Right now the federal government pays a share of the expenses anyone enrolled in Medicaid is charged. Limiting how much money the government spends on Medicaid would result in less coverage available to people who qualify for Medicaid: those with low incomes, those with disabilities, and those in long-term care.
The Congressional Budget Office estimated in March that more than 24 million people would lose health coverage under the original draft of the plan. Republicans voted on the revised plan before the office could release a new estimate including these changes.
During the House vote, the bill was opposed by all Democrats and 20 Republicans. The bill is also opposed by the American Medical Association, hospital groups, 27 advocacy groups for people with cancer, and other industry organizations.
Read our coverage on the AHCA to learn more about the bill. Below are some of the major changes included in the bill passed by the House of Representatives.
Essential Health Benefits
Under the ACA, essential health benefits are 10 categories of services all insurance plans must cover including hospitalization, mental health care, emergency room care, and maternity care. These have been popular with people who need health care, but requiring plans to cover these essential health benefits makes them more expensive.
The AHCA would allow states to choose not to require coverage of essential health benefits if the state can show that doing so would lower the cost of premiums or increase competition, which it could. Insurance companies could sell plans with lower premiums if plans did not have to include many benefits. But, cheaper plans with fewer benefits may not help if you get sick or injured, or if you have a pre-existing condition.
What This Means for You
If you have a serious medical condition like breast cancer, access to affordable health care plans that cover the services you need for treatment is essential. Under the AHCA, states can allow companies to sell plans that are cheaper, but may not cover the cost of expensive medical care like chemotherapy or hormonal therapy. In that situation, you may pay lower premiums for your insurance, but you may end up paying for much of your treatment costs out-of-pocket.
Currently insurance companies must sell plans to people with pre-existing conditions and charge the same price as they do for healthy people the same age. Republicans say the AHCA will still protect people with pre-existing conditions because the ACA rule that they cannot be turned down for a plan is being kept. While it’s true that no one will be denied coverage, the recent change to the AHCA will allow states to waive the rule that companies charge the same price for those plans.
States could, under the changed AHCA, allow insurance companies to charge people with pre-existing conditions higher premiums if the person has gone 63 days without insurance coverage. This price is before the 30 percent charge insurance companies can add to premiums for anyone trying to buy an insurance plan after those 63 days without coverage.
To waive this requirement the state would have to provide a high-risk pool or other program to help people with serious or chronic diseases.
What This Means for You
Keeping your insurance coverage is important. Not requiring every person to buy insurance may seem like a relief, but if you choose not to purchase insurance and decide you need it later, you may have to pay a large penalty on your monthly premium when you try to buy insurance again. If you have breast cancer and your state decides to allow companies to charge people with pre-existing conditions more, you may find yourself paying substantially more for insurance than you do now. Insurance companies make more money when people join who don’t need care and they have fewer sick customers to help pay for. Because fewer healthy people may buy insurance, companies may price their plans very high to discourage people with ongoing health needs from joining.
A high-risk pool could be your only option for affordable care, but these have been unreliable in the past. A lot depends on the process your state sets up for applying and how it budgets money for the high-risk pools. Coverage denials and waiting lists were common and could be devastating if you were in treatment and struggling to make payments before the ACA. Some high-risk pools would not cover pre-existing conditions for a full year after you signed up.
The AHCA finally passed the House when it included an additional $8 billion dollars to help states fund a high-risk pool or pay insurance companies for covering people with pre-existing conditions. But this is just a patch for the first couple years and many analysists have suggested that this is not enough to fund these high-risk pools. The protections will still be gone after that money runs out.
Currently, an insurance company can only charge an older person up to 3 times what it charges a younger person for the same plan. Under the AHCA this limit would be raised and companies would be allowed to charge an older person 5 times what they charge a younger person. The recent changes would allow states to opt out of this revised requirement as well. Insurance companies in those states could charge as much as they want to older people seeking insurance.
What This Means for You
As you get older you are more likely to have more health problems and, as a result, need more health services. Insurance companies do best when they have many young, healthy people paying premiums every month because they take in more money than they spend on health care for those people. If you are older, you may find your insurance premiums rise greatly simply because of your age.
If the AHCA passes the Senate and is signed by the president, it will be up to your state to keep or end these protections.
If you are concerned about parts of the AHCA, it is important to let your representatives at the state and federal level know how you feel. Call or write your Senator and share your story. The debate will continue and there is no guarantee the Senate will pass the law as it is written now.
LBBC will continue to update our Healthcare Newsroom about future developments and how they may affect you.