Absent from the half-time celebration at the White House of the one-vote passage of the American Health Care Act (“ACHA”) by the GOP-controlled House of Representatives, there was many statements about both premiums and deductibles going down and pre-existing condition coverage continuing as a result of this legislation. But no one in the rose garden or the rotunda of the capitol building was heard to utter the famous magic words associated with the Obamacare passage from day one: “If you like the health plan you have now, you can keep it!”
Certainly, it has been clear enough for a while that, under ACHA, if you are on Medicaid, you are looking at an $880 billion in overall funding reduction, so million of those depending on Medicaid coverage will lose at least part of that.
The same result applies for those who purchase policies on the Obamacare exchanges with direct subsidies from the federal treasury because those subsidies will be replaced by substantially lesser advanced tax credits that will, therefore, force choices for less generous coverage.
In addition, if your state chooses to waive the federal requirement that your individual (ie non-workplace) market plan include 10 “essential” coverage elements—like maternity and infant care, mental health, prescription drugs, hospitalization)—you will lose whatever benefits are waived no matter what your pay. And there will be even greater coverage degradation of existing policies if protections for those with a pre-existing medical condition (here’s list of them) are waived by your state and you somehow lose coverage for over 63 days, and in any event whatever coverage of your condition is not waived will cost a lot more.
But nobody on the GOP side has acknowledged that the famous “you can keep it” phrase regarding your family’s current health insurance policy quite possibly will no longer apply to the 160 million persons (nearly 50 percent of the marketplace) currently receiving their health care coverage through plans provided by their employers. How did this happen without virtually any public notice of this element of the GOP plan until the very morning it passed?
It should have been clear enough that at least those who work in many small businesses across America and get their health insurance though their employer would be at risk to losing coverage. The late-April revisions to the AHCA offering states the options to waive essential benefits and pre-existing condition protection against price discrimination would apply not only to the Obamacare exchange and individual marketplace but also to the small group market relevant to firms with 50-100 employees or less, depending on the relevant state regulations.
But even employees of our largest public and private companies could have their current coverage limited or eliminated, as the Wall Street Journal pointed out on the morning the House voted. Under the Obamacare rules now, a big company can choose the benefit package of any state to apply to its employees in all states—a rule that hardly matters while all policies are required to provide the ten essential benefits.
If just one state (as Wisconsin’s governor has already suggested he would consider) chooses to pursue the coverage waivers under the new AHCA, a big company could simply impose this “lowest common insurance denominator” of coverage to all its U.S. employees, unless the current rules are changed (but the ACHA leaves them place). As a further result, the Obamacare ban on lifetime caps on insurance benefits would also be undercut for any insurance coverage remaining after the waivers take effect. If you still think the GOP plan won’t affect you because you have a job with insurance, think again.
Neither the GOP generally, Speaker Ryan and his leadership team, nor President Trump ever campaigned on the platform to “repeal and replace your workplace health care policies.” It surely seems that somebody’s got some explaining to do: the town hall meetings during the current Congressional recess might be a good place to start.