Okay, so maybe I’ve been dragging my feet on it, but bear with me, because let me tell you, this stuff is as dense as molasses and then some. Yup, that’s right, I’m talking about the recent healthcare bill passed by House Republicans and being considered in the US Senate: the American Health Care Act (AHCA).
There’s been a whole lot of hysteria in the media in recent days regarding the AHCA and how it would (allegedly) revoke health insurance coverage for people with pre-existing conditions; a hallmark under President Obama’s Affordable Care Act (ACA). This assertion, however, isn’t entirely true. Let me explain.
In the broadest sense, the AHCA actually leaves a lot of what Obama and Congressional Democrats did in 2010 intact. That is, there are many parts of the Affordable Care Act that the ACA doesn’t even touch. The rule about staying on parents’ insurance as a dependent until 26? Still in place. The creation and maintenance of the state insurance exchanges set up by the ACA? Still there. People who have chronic or pre-existing conditions? Still able to get their healthcare.
Here’s what’s actually different between the two bills:
The individual mandate for the Affordable Care Act would be repealed, meaning the government cannot penalize you for not having health insurance. This, in my mind, would be an incredible reality. No one should be compelled to purchase a service they don’t want to utilize. If I want to roll the dice and not purchase health insurance that’s my business, not the government’s.
The American Health Care Act alters the tax credit awarded to individuals and families in need from one based on an income scale to a consideration of age and income. While I don’t see too much of a problem with this one way or the other, in theory by using age as the larger marker, those who are older (and thus generally have more health problems) will be given greater compensation.
The AHCA also removes a lot of government funding for Planned Parenthood and specifically the corporation’s abortive services. As someone who is pro-life and who disregards abortion in all but the direst of circumstances I cannot help but see this as a positive development towards an abortion-free society centered increasingly on adoption and the elevation of the familial unit. While I don’t want to see women (or men) lose vital access to necessary health services, abortion shouldn’t be one of them.
In addition, the new bill would remove penalties for large employers opting to not provide an in-house health insurance plan for employees, create the option for states to set up work requirements for able-bodied individuals receiving Medicaid, remove family planning from select Medicaid grants, and remove Medicaid funding of Planned Parenthood. These differences are a little bit trickier for me, considering I don’t believe total abolition of family planning services is the way to go and I'm ambivalent about the possible removal of employer-based health plans already in place, but by and large I think they are a step in the right direction. After all, requiring individuals to do some work in exchange for the government’s payment of services is far from a novel idea (ever heard of federal work study, my fellow college students?).
The last discrepancy between the ACA and the AHCA is the one that probably gives me the largest hang up, and is also the one that has (coincidentally) been talked and talked to death by media pundits ever since the House vote on the bill almost a week ago now.
The AHCA allows for individual states to apply for waivers to redefine the “10 essential health benefits” that were codified in the ACA, as well as for the right to place individuals with pre-existing conditions who are looking to buy health insurance in high-risk pools that would help quell the rise in insurance premiums that have been seen since the ACA took its largest effect in 2014.
This is the case where liberal talking heads have claimed that Republicans are punishing the sick and the elderly be taking away their healthcare. If you read over the details, this simply isn’t the case. You still will not be denied coverage because of your pre-existing condition. You won’t even be placed in a high-risk pool (i.e. insurance group with other people with pre-existing conditions) if you maintain coverage on your current plan with no gap in coverage of more than 63 days and if you do not live in a state that has applied and obtained a specific waiver from the federal government. To offset an increase in costs any states might encounter in the case they might apply for such a waiver-based program, which they only might get, the government has set aside an additional $8 billion in funding.
And, to top it all off, any state that is granted one of these waivers must be able to prove that the alternative plan they have set in place can provide “financial help for high-risk individuals, to stabilize private insurance premiums, promote access to preventative services, provide cost sharing subsidies, for maternity coverage and newborn care, for mental health and substance use disorder services”. If these provisions can’t be met, then the waiver can be denied by the apparatus that will eventually oversee such applications.
So, is this a perfect system? No. Might people with pre-existing conditions have to pay more for insurance? Might family planning services see a reduction because of some cuts? Yes. But, by and large these are either localized occurrences or services that will be offset by other funding and other organizations. Meanwhile, the removal of the individual mandate will grant more freedom to individuals to decide whether or not they would like to purchase a product they may not even feel they need, and the reduction/elimination of many taxes will keep more money in the people’s pockets. Not to mention, the restructure should drive down the cost of insurance premiums, one of the main failings of the Affordable Care Act.
In all, the American Health Care Act is not perfect. I am eager to see what proposals the Senate has to better it. Yet, as a whole, it is far from the snake oil that the news media is making it out to be.