GOP replacement plans for Obamacare do not live up to claims of protecting people with pre-existing conditions, prohibiting health status discrimination, prohibiting lifetime or annual limits, reducing costs for consumers, and many other promises.
This is true for every plan proposed so far, but in this article, I focus on the bill introduced in the US Senate on Monday, January 23, by Bill Cassidy (R-LA): S.191, the Patient Freedom Act (PFA) of 2017. This bill is co-sponsored by Susan Collins (R-ME), Johnny Isakson (R-GA), and Shelley Moore Capito (R-WV).
The problems with this bill are too numerous to cover in one post, so in part 1, I focus on the gist of the bill and its failure to protect people with pre-existing conditions or to prevent health status discrimination.
The Gist of the Bill: Healthcare in the Hands of States
The bill essentially gives the states three options: (1) retain ACA with federal funding; (2) replace ACA and use the same amount of federal funding to go toward market-based insurance and federally funded Roth Health Savings Accounts (HSAs), automatically enrolling state residents in a basic coverage plan with a high deductible; or (3) create a state plan without any federal funding.
So the plan essentially puts healthcare into the hands of the states, despite the damage states did to their economies and the health of their citizens when opting out of the ACA Medicaid expansion (insuring fewer people and causing their own Medicaid costs to more than double those of states that accepted the expansion).
If you live in one of the states that declined or delayed Medicaid expansion under the ACA, you likely lost money as a taxpayer and/or had fewer affordable options for adequate insurance as a result of your state government’s healthcare-related choices. This is one example of why it is crucial to pay attention to what our state legislators and governors are doing.
Pre-existing Conditions and Health Status Discrimination
Option 2 in the PFA of 2017 is the key piece of this bill, and many elements of this option are concerning, particularly the disconnect between what the bill promises and what it actually provides. This is particularly the case with the sleight-of-hand promises to preserve popular and crucial provisions of the ACA, such as prohibiting insurers from denying or jacking up prices on coverage for people with pre-existing conditions or discriminating against people based on health status factors (such as weight, high cholesterol, exercise habits, and so forth).
Sounds great, right? It is, but here’s the catch: You lose these protections if you do not have continuous coverage. For millions of Americans living paycheck to paycheck, the likelihood of missing premium payments is high. Even those in the middle class who aren’t struggling could easily miss payments if they get seriously ill and need to put their money toward a high deductible or simply lose track of making the payments while hospitalized or recovering at home.
This is not to mention the incentive this gives insurance companies to find ways to break insurees’ continuous coverage in order to drop the more costly people from the plan and charge them more to restart insurance. The insurer merely needs to complicate the process for consumers to appeal the break and enough people will give up or not even try to tackle the time-consuming process of paperwork and telephone hot potato that insurers could require.
Maintaining continuous coverage is particularly burdensome for the working poor who make too much to be eligible for Medicaid. This includes people working long hours or two or more jobs and many single parents who have little if any time to spare jumping through insurance company hoops but also are most likely to struggle making premium payments and meeting the high deductibles of the default insurance plan that residents will automatically be enrolled in.
And on top of all this, the bill stipulates a late enrollment penalty, so if you can’t afford continuous coverage, you will owe even more money, making it even more difficult to pay your premiums and deductibles, which are likely much higher now that the insurer can use medical underwriting to increase your payments based on pre-existing conditions and health status.
To be fair, the bill does allow people to opt out from being insured, including from the state plan autoenrollment. Those who opt out from this and other insurance will be able to get insurance in the future with protections in place. So those who fear that being insured through the PFA 2017 will potentially ruin them financially can just forego insurance altogether and hope they do not get seriously ill or injured.
In other words, the Patient Freedom Act of 2017 gives millions of Americans one choice: Your money or your life.
Featured image courtesy of TaxRebate.org.uk