"If you eliminate [the federal essential health benefits] requirement you could see a lot of state variation, and there could be an incentive for companies that are looking to save money to pick a state" with skimpier requirements, said Sarah Lueck, senior policy analyst at the Center on Budget and Policy Priorities.
Q: I keep hearing that nobody in the United States is ever refused medical care — that whether they can afford it or not a hospital can't refuse them treatment. If this is the case, why couldn't an uninsured person simply go to the front desk at the hospital and ask for treatment, which by law can't be denied, such as, "I’m here for my annual physical, or for a screening colonoscopy"?
If you are having chest pains or you just sliced your hand open while carving a chicken, you can go to nearly any hospital with an emergency department, and — under the federal Emergency Medical Treatment and Active Labor Act (EMTALA) — the staff is obligated to conduct a medical exam to see if you need emergency care. If so, they must try to stabilize your condition, whether or not you have insurance.
The key word here is "emergency." If you're due for a colonoscopy to screen for cancer, unless you have symptoms such as severe pain or rectal bleeding, emergency department personnel wouldn't likely order the exam, said Dr. Jesse Pines, a professor of emergency medicine and health policy at George Washington University, in Washington, DC. "It's not the standard of care to do screening tests in the emergency department," Pines said, noting in that situation the appropriate next step would be to refer you to a local gastroenterologist who could perform the exam.
Even though the law requires hospitals to evaluate anyone who comes in the door, being uninsured doesn't let people off the hook financially. You'll still likely get bills from the hospital and physicians for any care you receive, Pines said.
Q: The Republican proposal says people who don't maintain "continuous coverage" would have to pay extra for their insurance. What does that mean?
Under the bill passed by the House, people who have a break in their health insurance coverage of more than 63 days in a year would be hit with a 30 percent premium surcharge for a year after buying a new plan on the individual market.
In contrast, under the ACA's "individual mandate," people are required to have health insurance or pay a fine equal to the greater of 2.5 percent of their income or $695 per adult. They’re allowed a break of no more than two continuous months every year before the penalty kicks in for the months they were without coverage.
The continuous coverage requirement is the Republicans' preferred strategy to encourage people to get health insurance. But some analysts have questioned how effective it would be. They point out that, whereas the ACA penalizes people for not having insurance on an ongoing basis, the AHCA penalty kicks in only when people try to buy coverage after a break. It could actually discourage healthy people from getting back into the market unless they’re sick.
In addition, the AHCA penalty, which is based on a plan’s premium, would likely have a greater impact on older people, whose premiums are relatively higher, and those with lower incomes, said Sara Collins, a vice president at the Commonwealth Fund, who authored an analysis of the impact of the penalties.
A Quiz to test your memory of the AHCA: On May 4, 2017, the US House of Representatives approved the American Health Care Act (AHCA), legislation to repeal and replace the Affordable Care Act (ACA). On May 24, the Congressional Budget Office scored the latest version of this bill. Do you think you’re an expert on the AHCA? Take this quiz to test your knowledge.
*Kaiser Health News (KHN) is a nonprofit news service committed to in-depth coverage of health care policy and politics. And we report on how the health care system — hospitals, doctors, nurses, insurers, governments, consumers — works.
Editor's Note: H.R. 1628, American Health Care Act of 2017 as examined by the Congressional Budget Office:
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