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3 Things You Should Know About the GOP's Latest Health Care Plan

Apr 26, 2017

The latest amendment proposed for the American Health Care Act, the House Republican's planned replacement to the Affordable Care Act, would leave even fewer people insured than the original draft and raise costs for many more.

The amendment was introduced Tuesday night by New Jersey Rep. Tom MacArthur to appeal to the far-right Freedom Caucus, according to reports. But while the most conservative members of the House may be more amenable to this draft of the AHCA, it does nothing to address the coverage losses and pricing issues that were sticking points in the previous version—in fact, this amendment looks to exacerbate them.

Here are three things consumers need to know about the latest iteration of the Republican plan:

1. Pre-Existing Conditions Will Cost You

Under the current GOP plan, states would be able to seek a waiver to the ACA's community rating provision— which requires insurers to set premiums for entire communities of people, not on an individual basis—if the states participate in the Patient and State Stability Fund. The states would decide how they use the money from the fund, but one option that's been endorsed by House Speaker Paul Ryan is the establishment of high-risk pools for the sickest Americans.

As we reported yesterday, high-risk pools are separate health insurance markets for people who are denied coverage on the individual market because of their pre-existing conditions. Before the passage of the ACA, the plans offered in these pools were exorbitantly expensive, had annual and lifetime caps, and didn't cover as much as plans on the individual market did.

In effect, the new GOP health plan would allow people with pre-existing conditions—which can include anything from cancer to obesity to being a woman of child-bearing age—to be charged more for worse coverage.

What's possibly worse is that states don't have to create these pools with the money from the fund—meaning those with pre-existing conditions could face even more astronomical costs in the individual market, pricing them out of it.

According to Politico, the amendment also strengthens the continuous coverage provision, which allows insurers to charge people with pre-existing conditions more if they have gone without health insurance for a period of time.

Meanwhile, a Washington Post-ABC News poll released Tuesday night found that 70% of Americans think the states should protect people with pre-existing conditions.

2. Essential Health Benefits Would Become Optional

Under the ACA, 10 categories of care, called Essential Health Benefits, must be covered without a co-pay in every plan offered on the marketplace. EHBs include things like emergency services, overnight stays at the hospital, maternity and newborn care, mental health care, preventive care (like birth control), and more.

But the newest iteration of the AHCA would allow states to seek a waiver to this provision if they show that the change would reduce average premium costs in the state.

Just as before Obamacare was passed, health insurers will no longer have to cover basic health services without a co-pay or co-insurance. In other words, premiums will certainly decrease—or should, considering the plans will undoubtedly cover less—but consumers are going to pay more out-of-pocket for basic health care, like primary care checkups.

3. Older Americans Will Be Charged Significantly More

The third big change for consumers is that the insurers would be able to charge older Americans significantly more once again for health care coverage starting in 2018, since their coverage is typically more expensive than younger peoples'.

As we previously reported, "the oldest consumers on the individual market are 64, just shy of the Medicare eligibility age of 65, and under the Affordable Care Act they can be charged no more than 3 times what a 21-year-old would pay." The AHCA would allow those 64-year-olds to be charged 5 times as much, all while decreasing subsidies.

That means the only people who would possibly fare better under this plan are the youngest, healthiest Americans, living in states that decide not to restrict essential health benefits.

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