Although the House has not released all the details on a revised Republican plan to replace and repeal Obamacare, the Florida AARP says that over the past few days, they’ve learned enough to be concerned.
The senior advocacy group believes that about 454,000 Floridians age 50-64 enrolled and receiving tax credits in the ACA Marketplace would see higher health coverage premiums than they are currently paying, more than in any other state.
The American Health Care Act withered last month after House Speaker Paul Ryan pulled the American Health Care Act from the floor when it became clear it didn’t have the votes. Most members of the conservative House Freedom Caucus said at the time they would not vote for the bill as it was written.
One of the changes announced in the new plan would make it so insurers could secure a federal waiver that kept them from having to cover certain essential health benefits established by the federal government, and while it would still require that people with pre-existing conditions receive coverage, they could be charged higher premiums. That’s being called the MacArthur Amendment, named after New Jersey Republican Tom MacArthur, co-chair of the moderate Tuesday Group.
Though a state like Florida might not want to secure that waiver, Jeff Johnson from the Florida AARP says that if the GOP plan ultimately allows buying coverage across state lines. This could still permit Floridians to purchase this health insurance “lite” plan for a low premium “perhaps not knowing that they’re not getting the coverage they would expect health insurance to cover.”
In turn, those with chronic conditions would be unlikely to choose a plan that wouldn’t cover a condition that they already have, and more likely purchase a more complete plan.
The problem with that, Johnson says, is if the healthiest people are paying for a cut-rate plan, forcing sicker people to buy a full plan, it will drive those costs up.
“So it affects those who don’t fall for the health-insurance-lite trick,” says Johnson.
Current essential benefits include:
— Outpatient care (essentially doctor visits outside the hospital)
— Emergency services
— Pregnancy, maternity, and newborn care
— Mental health and substance use disorder services
— Prescription drugs
— Rehabilitative and habilitative services and devices, which help people with injuries and disabilities to recover
— Laboratory services
— Preventive care, wellness services, and chronic disease management
— Pediatric services, including oral and vision care for children
Another element in the new plan would allow states to end its “community rating” provisions. This would allow states to deny coverage to people with pre-existing conditions, by creating so-called “high-risk pools” for individuals with pre-existing conditions.
“We’ve had high-risk pools in the past, and they’ve never really worked,” says Johnson. “They don’t bring in the people who need it. They’re not able to offer insurance at rates that real people can afford who actually need it, and I don’t know that there is anything that would lead us to believe that the results would be different this time around.”
Another element that Florida AARP says they’re trying to get clarity on is language that would allow states to offer a different age rating than the 5:1 that’s in the original AHCA bill. That ratio breaks down into charging those 50-64 up to five times more than those in their 20s. The AARP says that number could go higher, which “could mean worse,” said AARP’s Jeff Johnson.
Stella Mariani-Gonzalez was diagnosed with stage three breast cancer in 2001 and ultimately spent hundreds of thousands on her treatment, after her original insurance company said they would only pay for four chemotherapy treatments. She said it was cheaper to remain uninsured after she recovered, and pay out of pocket for routine annual exams until she signed up for the Affordable Care Act in 2014.
“For the first time in years,” she said, “we had the relief of actually being able to afford health care.”
Mariani-Gonzalez acknowledges that she’s had to change doctors “a few times” and has large deductibles.
“At least I know I have something, after hearing about these high-risk pools, it’s just devastating,” she said. “I can’t imagine having to go back to that again.”
AARP also prepared a new analysis examining how Floridians of modest means would fare under the House health plan coverage, outside of high-risk pools for those with pre-existing conditions.
The report shows that in eight Florida counties, premium costs for those aged 50-64 would eat up most, or in some cases all, their annual income.
For example, a Miami-Dade County resident age 64 with an income of $15,000 a year would see an effective premium increase of $11,666 per year, or 77 percent.
In Collier County, a similar individual would see a premium increase of $15,923, actually more than their entire annual income.
A person age 64 in Miami-Dade County with income of $25,000 a year would see effective premium increases of $10,272. In Collier County, a similar person would see an effective premium increase of $14,529.
While political prognosticators think the newly revised plan could get through the House, there still are no guarantees it would survive in the Senate, where the rules governing the Senate’s reconciliation process requires all changes to have a direct effect on the federal budget. It’s also doubtful such a bill could they garner 60 votes to overcome a filibuster.