House Republicans Introduce Healthcare Bill

American Health Care Act Keeps Some Patient Protections but Could Mean Less Financial Help for Many
Breast Cancer News
March 15, 2017
Eric Fitzsimmons

Republicans in the House of Representatives introduced two bills that would take the place of the Patient Protection and Affordable Care Act, also known as the ACA or Obamacare. The plan, known as the American Health Care Act, has received support from the Trump administration and would fulfill the Republican promise to repeal the ACA.

The American Health Care Act keeps some protections from the ACA that are popular and that people have voiced support for in meetings with their members of Congress:

  • Young adults can get insurance through a parent’s plan until they are 26 years old.
  • Insurance companies cannot deny coverage to you or charge you more just because of a pre-existing conditioninfo-icon.
  • Insurance companies cannot put an annual or lifetime limit on what they will cover.

Other parts of the ACA, including the Medicaidinfo-icon expansion, the requirement that people buy insurance and financial assistance programs for people with low incomes, will be repealed or changed in ways that could affect how you get health coverage.

Republican leaders hope to move the bill through Congress quickly but it faces opposition from the Democrats in Congress as well as some Republicans.

Individual Mandate Versus Continuous Coverage

One of the least popular parts of the ACA is the individual mandate, which requires you to sign up for health insurance or pay a fine. If passed, the American Health Care Act will not require you to have insurance, but if you go without coverage for more than 63 days, companies will be able to charge you more when you try to buy insurance again. For example, if you go 3 months without insurance, you can be charged up to 30 percent more than the standard rate on an insurance plan if you try to buy health insurance on your own (if you are not able to get insurance through your employer or a government health program). This extra charge will apply to your premiums through the first year of coverage.

What This Would Mean for You

Many people with breast cancer find they cannot continue to work during treatment. You may need to leave work for some time or take a job with fewer hours. And sometimes, leaving work or working fewer hours impacts whether your employer will offer you insurance coverage. It is important to maintain some form of health coverage during these transitions, even if you are not in active treatment. Under this new bill you would be “allowed” to go without health insurance, but would find premiums are very expensive with the 30 percent extra charge if you need to buy a plan later.

Medicaid Reduction

Many people got coverage from the Medicaid expansion under the ACA. Medicaid is a program that provides health coverage for people with low incomes. It is run by the states, but the federal government pays a share of the cost. For people who have Medicaid through the ACA expansion, the federal government pays over 90 percent of their health care costs, and for people who got Medicaid under pre-ACA rules, it pays about half the cost of care. The ACA Medicaid expansion was put into effect by 31 states, so there are many states where people were not enrolled as part of this policy.

The American Health Care Act would end the ACA’s Medicaid expansion in 2020. The expansion would continue until then in states that already run it. After 2020, people who were enrolled as part of the Medicaid expansion and who do not have any breaks in coverage will continue to be covered, but the federal government will not contribute to any new enrollees.

All states will be affected by the change in how the federal government shares the cost of people who qualify for Medicaid under the pre-ACA rules. Under the American Health Care Act, instead of paying a portion of Medicaid costs, the government will pay a fixed dollar amount per person. The allotment would change according to the needs of different groups of people: The amount given to the state for a child’s care would be different from the amount given for a person with a disability, for example. States would have flexibility in how to use the funds for its Medicaid program, but that could mean cuts that result in coverage that doesn’t meet people’s needs, especially for cancer patients.

The ACA allowed many people who could not afford health insurance to get coverage through Medicaid. This was rejected by 19 states where state lawmakers opposed the ACA. Because the new law doesn’t propose to end Medicaid expansion immediately, some people believe lawmakers won’t end it. Several states with Republican leaders strongly support continuing the program. Other Republicans have proposed ending the Medicaid expansion earlier, in 2018 rather than 2020.

What This Would Mean for You

If you are making less than $16,000 (for an individual) and live in one of the 31 states that expanded Medicaid, you are likely eligible for Medicaid under the ACA expansion. After the expansion ends, however, good health coverage may be harder to afford. The financial assistance under the American Health Care Act is not based on income and may not be enough to make the health insurance you need affordable.

Tax Credits

The ACA set up online marketplaces, run by your state or the federal government, for people looking to buy individual health insurance, plans you buy for yourself not provided through an employer. Through these marketplaces, people are also able to get subsidies, financial assistance to pay for insurance. The amount of the subsidy is based on your income and the average cost of insurance in your area.

Under the American Health Care Act, tax credits towards buying individual insurance plans will be given based on your age. Older Americans, who usually need more health care, will get the bigger tax credits in this plan. Younger people will get smaller tax credits, because they tend to be healthier and need less medical care. For example, someone under age 30 could get $2,000 toward buying insurance, but someone 60 years or older would get $4,000.

This bill does have a cap on these credits. Only people making less than $75,000 (or couples making $150,000) get the full credit. For every $1,000 a person makes over that figure, $100 is taken from the tax credit until their tax credit has run out.

Capping the income level for tax credits addresses concerns that aging millionaires would get more assistance from the government than someone in their 30s who is struggling financially. But it still directs more financial assistance to people who are wealthier. Under the ACA, a person making more than $50,000 a year is not eligible for subsidies, but a 60-year-old making $70,000 would get the most financial help under the age-based tax credits.

What This Would Mean for You

How this will affect your access to health insurance depends largely on your age, income and location. If you make more than $50,000 you may get more help than you received under the ACA, but if you make under $30,000 you will probably get less help from the government.

The price of insurance in your area will also affect the change you see. The ACA would provide a bigger subsidy based on the average rate in your area, but the American Health Care Act tax credit will be the same across the country. If you are in an area with high insurance rates, you would get the same tax credit as someone the same age living near a city that has plans available with lower premiums. In the states with the highest insurance costs, individuals may see a large reduction in the assistance they will receive.

A smaller tax credit will make it harder to afford the plans you need when getting treatment for breast cancer. Plans with cheaper premiums may be available, but usually lead to more out-of-pocket costs when you have to pay for appointments, medicines or hospital stays.

Age Bands

The ACA said insurance companies could not charge older people, who usually use more health care, more than three times what they charge younger people. The American Health Care Act will raise that limit allowing companies to charge older people five times what they charge young customers.

What This Would Mean for You

If you are an older citizen, you likely spend more on health care than people younger than you. Because of this, you also likely pay more in insurance premiums. If you make less than $50,000 a year, you may find getting the bigger tax credit because of your age will not make up for these higher premiums. The American Health Care Act tax credit will likely be less for you than subsidies available from the ACA, which are connected to income and the cost of premiums in your area.

State Grants

The American Health Care Act does set aside $100 billion to be given over 9 years to the states. The states could use this money to help people pay insurance premiums, hospitals that care for people who can’t pay their bills, insurers who have taken on people who need costly care, or to form high-risk pools, a policy that several states tried before the ACA but that left many people with serious or chronicinfo-icon conditions without coverage.

What This Would Mean for You

How these funds are used will be up to individual states. Your state may use it to help you pay for insurance or health care, but it may go towards institutions with no direct help for you.

Planned Parenthood

The American Health Care Act will prevent Planned Parenthood clinics from taking payments through Medicaid or family planning grants. Planned Parenthood provides health and wellness services like treatment for sexually transmitted infections, annual well-woman exams and screenings for breast and other cancers.

Planned Parenthood accepts Medicaid and provides these services to many people who have low incomes and get health coverage through that program. But because Planned Parenthood also provides abortion services, some groups want to stop any government money going to the organization.

The federal government also gives family planning grants to help clinics that provide services including breast and cervical cancer screenings, STI preventioninfo-icon, fertilityinfo-icon services and birth control education and services. Some of these grants go to Planned Parenthood clinics that provide these services.

What This Would Mean for You

If you go to Planned Parenthood for screenings or services and are on Medicaid, you may have to change where you go for care. This could also affect Planned Parenthood’s ability to keep some clinics open, in which case you may have to find a new provider even if you don’t use Medicaid.

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