Buzz
There’s been a lot of focus on the 22 million people projected to lose coverage under the Better Care Reconciliation Act, along with the rising costs for those buying insurance individually. But what if you're someone who gets coverage through your employer? It turns out that you’re not exempt from the consequences of this bill, and the news isn’t great for anyone.
By the way, labeling this as bad news isn’t a political stance. Just 17% of Americans support the bill, with even fewer Republicans in favor. It's also opposed by the American Medical Association, the American Association of Retired Persons, the American Hospital Association, the American Cancer Society’s advocacy network, the American Association of Medical Colleges, the Catholic Health Association, and many others. To be honest, I’m getting tired of typing all these 'Associations'—I think you get the point.
Here’s what will happen to the health insurance provided through your job if the bill is approved by the Senate this summer and passes through the House and the President’s desk:
Your Employer Won’t Be Obligated to Provide Insurance to You Anymore
Under the ACA, businesses with 50 or more full-time workers were required to provide meaningful, relatively affordable insurance coverage. The new healthcare bill removes the penalty that companies faced if they didn’t provide insurance, essentially eliminating the rule. While many companies will likely continue offering health insurance as a benefit, it’s unclear how many. (The CBO estimate simply states that 'some' employers will stop offering coverage.)
Lifetime Limits Are Set to Return
When you enrolled in your health insurance plan, you likely noticed an out-of-pocket maximum: no matter how high your medical bills climb, you won’t pay more than a set amount, such as $12,000 in a year. This includes major expenses like cancer treatments or a premature baby requiring extended NICU care and multiple surgeries.
However, before the Affordable Care Act, insurance policies often had a different kind of limit: a cap on how much the insurer would cover. If your medical costs exceeded a certain amount, say $200,000, your insurer could stop paying, leaving you to cover any additional expenses yourself.
There were also lifetime limits. A premature baby could quickly exhaust her lifetime medical coverage before even leaving the hospital. The ACA (commonly known as 'Obamacare') outlawed both annual and lifetime limits, ensuring that 105 million people no longer had to fear hitting a coverage cap in the midst of critical treatments like chemotherapy. The Senate bill, however, seeks to reverse the law that prohibits these caps.
Insurance Companies Can Waste More of Your Premium Money
Under the ACA, insurance companies were required to allocate 80% of your premium dollars toward actual care, not administrative costs or executive salaries. This rule, known as the medical loss ratio, helped to keep premiums lower. The BCRA eliminates this provision, allowing insurers to spend as much of your premium as they wish on themselves, rather than on your healthcare.
You're in Trouble If You Lose Your Job
Employer-provided insurance only works as long as you're still employed. If you lose your job, you may be able to keep your insurance through COBRA, but the premiums are typically much higher because your employer will no longer contribute to the cost.
If you go without insurance for 63 days or longer, and then try to buy individual insurance (commonly referred to as an 'Obamacare plan'), you’ll be barred from coverage for six months. This provision in the healthcare bill is designed to pressure people into maintaining continuous coverage, as it would eliminate the tax penalty for being uninsured.
When you do purchase an individual plan, it will cost you more—on average, 74% more—compared to the same plan under the ACA. (So when you hear that premiums will be lower under Trumpcare, remember that’s referring to less coverage, not a fair apples-to-apples comparison.)
Clinics Could Shut Down or Cut Services
Providers that serve many Medicaid patients, including children’s hospitals, will be hit hard by the bill’s major cuts to Medicaid. Dipesh Navsaria, a pediatric professor at the University of Wisconsin School of Medicine and Public Health, points out that Medicaid covers much of the care for sick children, so children’s hospitals may lose enough funding to the point where they’ll have to either shut down or reduce the services they provide. This affects everyone, as children’s hospitals also play a crucial role in training new doctors and advancing medical procedures.
If you receive checkups at Planned Parenthood, this bill is threatening that access too. There’s a provision that would stop reimbursements for providers through Medicaid or other government programs when patients visit a specific type of clinic. Planned Parenthood is the only clinic that fits this description. Planned Parenthood serves many low-income individuals on Medicaid and also provides government-funded birth control. If this provision passes, it could jeopardize the health of those individuals and threaten the very existence of Planned Parenthood. In fact, in over 100 counties, Planned Parenthood is the only clinic of its kind.
