GOP’s Health Bill Could Undercut Some Coverage In Job-Based Insurance; A Quiz to Test Your Memory of the AHCA
Editor's Note: H.R. 1628, American Health Care Act of 2017 as examined by the Congressional Budget Office (links on page 2); and a quiz to test your knowledge ...
By Michelle Andrews May 23, 2017
This week, I answer questions about how the Republican proposal to overhaul the health law could affect job-based insurance and what the penalties for not having continuous coverage mean. Perhaps anticipating a spell of uninsurance, another reader wondered if people can rely on the emergency department for routine care.
Q: Will employer-based health care be affected by the new Republican plan?
The American Health Care Act that recently passed the House would fundamentally change the individual insurance market, and it could significantly alter coverage for people who get coverage through their employers too.
Kaiser Health News contributing columnist Michelle Andrews writes the series Insuring Your Health, which explores health care coverage and costs. To contact Michelle with a question or comment, click here.
The bill would allow states to opt out of some of the requirements of the Affordable Care Act, including no longer requiring plans sold on the individual market to cover 10 “essential health benefits,” such as hospitalization, drugs and maternity care.
Small businesses (generally companies with 50 or fewer employees) in those states would also be affected by the change.
Plans offered by large employers have never been required to cover the essential health benefits, so the bill wouldn’t change their obligations. Many of them, however, provide comprehensive coverage that includes many of these benefits.
But here’s where it gets tricky. The ACA placed caps on how much consumers can be required to pay out-of-pocket in deductibles, copays and coinsurance every year, and they apply to most plans, including large employer plans. In 2017, the spending limit is $7,150 for an individual plan and $14,300 for family coverage. Yet there’s a catch: The spending limits apply only to services covered by the essential health benefits. Insurers could charge people any amount for services deemed nonessential by the states.
Similarly, the law prohibits insurers from imposing lifetime or annual dollar limits on services — but only if those services are related to the essential health benefits.
In addition, if any single state weakened its essential health benefits requirements, it could affect large employer plans in every state, analysts say. That's because these employers, who often operate in multiple states, are allowed to pick which state’s definition of essential health benefits they want to use in determining what counts toward consumer spending caps and annual and lifetime coverage limits.
Pages: 1 · 2
More Articles
- FDA Finalizes Historic Rule Enabling Access to Over-the-Counter Hearing Aids for Millions of Americans More Affordable Hearing Aids Could Be in Stores as Soon as Mid-October
- Emily's List Statement On Voting Rights Vs Senator Sinema's Lack of Support for Legislation on Voting Rights
- The Uber and Lyft of Dog Walking Fight State Oversight
- Poll: Democrats Say They Are Hearing Enough From Presidential Candidates About Medicare-for-All and Expanding Coverage, But Want Them to Talk More about Health Costs and Women’s Health Care
- The 'You Have a Right to Know' Rule: Transparent Hospital Pricing Exposes Wild Fluctuation, Even Within Miles
- The Donut Hole and Closing the Medicare Part D Coverage Gap: Trends, Recent Changes, and What’s Ahead
- From FactCheck.org: Trump Nixed Gun-Control Rule: The Obama administration estimated that the reporting requirement would cover "approximately 75,000 people each year who have a documented mental health issue"
- No One Is Coming: Hospice Patients Abandoned At Death's Door
- Trump Executive Order Will Create a Health Insurance Race to the Bottom; Going Back to the Days of Junk Insurance and Insurers That Cannot Pay Claims Hurts Consumers
- Congressional Bills Introduced on Sexual Harassment, AMBER Alert Grants for Indian Tribes, Encouraging STEM Education, Holistic Solutions to Families in Need