Let’s start positive: Here are the best things about the new health-insurance plan rolled out by Republicans in the House of Representatives. It would require insurers to offer coverage regardless of a person’s pre-existing health conditions. It would not allow insurers to place a lifetime cap on benefits. And it would continue to allow children to remain on their parents’ insurance until age 26.
In other words, the only good aspects of the proposal to repeal and replace the Affordable Care Act are the things it would keep from the Affordable Care Act. The rest of the bill is bad news for Americans and the future of their health.
To be sure, the continuation of coverage, regardless of pre-existing conditions, is especially important for people with diabetes, whose bills often mount over the course of time and who, in the days before health insurance reform, were often refused individual coverage.
But the would-be ACA replacement leaves plenty for Americans with diabetes—and for all Americans—to fret about if the still-sketchy plan rolled out by Republican lawmakers this week comes to fruition. Affordability would worsen. Millions of people would go without insurance. The people who most need help affording insurance appear likely to get the least assistance. Coverage for necessary hospitalization, mental health services and maternity care, required under ACA, would be left to individual states.
The defunding of Planned Parenthood, also part of this ideological package, wouldn’t change a thing about how many abortions are performed, because by law, federal funding already cannot be used for abortions. But it would shrink access to affordable mammograms, routine gynecological exams and contraceptives.
Gone would be the individual mandate, requiring every American to carry health insurance or incur a tax penalty. This is bad news for those with chronic conditions; without abundant numbers of healthier people in the insurance pools, those pools would collapse. The result: spiraling premiums for people with diabetes and other pre-existing conditions.
And the replacement for the mandate would make things even worse: Insurance companies could demand a steep surcharge—30 percent—to people who have allowed a gap in their health coverage.
That’s simply backward. The people who stop buying health insurance don’t do so because they can easily afford the premiums. They do it because they find the insurance too expensive. An ultra-costly re-entry fee would only discourage them from returning to the insurance market. Sure, healthy young people might unwisely decide not to buy insurance even if they can afford it, but they’re not thinking 25 years ahead to when they might not be in such robust shape and will need that coverage.
Tax credits to help people afford health insurance would lopsidedly benefit those with higher incomes. To see how that would work, take a look at the convenient interactive map put together by the Kaiser Family Foundation, pick a state, and play with the numbers at the side of the map. For my state, California, a 60-year-old with an income of $100,000 would receive a tax credit more than 75 percent larger than the one under ACA. Under the House plan, a person of the same age with a $30,000 income would receive a considerably smaller tax credit than under ACA.
Reductions in Medicaid expansion coverage after 2020 would further reduce coverage for the poor.
Overall, what this proposal promises is that people would be able to buy coverage regardless of their medical conditions—but only if they already have plenty of money. People with diabetes and other pre-existing conditions would likely pay much higher prices for worse coverage. Millions of people would simply return to the rolls of the uninsured.
It’s early in the legislative game, though Republican congressmen are trying to push this through before it can even undergo the usual analysis. Can’t blame them; any real scrutiny would bring this crashing down once people got a chance to see how badly off the country would be. Many people didn’t like the individual mandate of Obamacare, but will they like insurance with higher prices and huge coverage holes any better?
The best hopes for the nation might come from two sets of Republicans: extremely conservative lawmakers, and those with moderate leanings. To the extreme right, even this legislation looks like socialism; moderates, meanwhile, are taking the time to worry about the reaction they’ll see among constituents who are left without health insurance. It won’t be a happy one.