Donald Trump and conservatives in the US House have reportedly come up with a new compromise to gut the Affordable Care Act, aka Obamacare.
Under the new Trump/Ryan plan, states would be able to opt-out of the ACA’s pre-existing condition protections and basic benefits requirements.
1) Add your name to those demanding Congress not repeal the ACA or any of its benefits.
2). Then, follow up with an email to your members of Congress.
Pre-existing conditions protections to be removed
Under the ACA, insurance companies are no longer permitted to refuse you coverage, or charge you more for coverage, because of a pre-existing health condition. In the past, something as slight as asthma or gastritis was enough for insurance companies to refuse to sell you a plan, or to charge you an exorbitant price for lousy coverage. Under Obamacare, insurance companies must charge you the same rate they charge everyone in your geographic area and age group.
Under the new Trump/Ryan plan, states can opt-out of the pre-existing conditions requirement, and instead set up “high-risk” pools — basically, insurance ghettos. People with pre-existing conditions, from allergies to cancer, would be forced to buy insurance on a separate market where they could be charged practically anything, and there’d be no guarantee that the coverage would be any good. Many states had high-risk polls pre-Obamacare, and they routinely failed because they weren’t sufficiently funded, there were long waiting lists to even get into the pools, and people couldn’t afford the high premiums.
Basic benefits guarantee to be removed
Under the ACA, every insurance plan has to offer you a basic package of 10 essential benefits, including prescription drugs, maternity, emergency care, mental health, lab services, and more. Under the new Trump/Ryan plan, states can opt-out of the essential benefits, permitting them to pare down plans, excluding all sorts of important benefits, the way they used to.
But that’s not all the ACA did
Before the ACA, many insurance plans had annual and lifetime limits. My plan, for example, only let me buy $1,200 worth of prescription drugs per year. And while that may sound like a lot, my one asthma drug, Advair, costs around $300 or more per month.
But that’s not all. Many plans had an annual or lifetime limit on all coverage. Meaning, if you have cancer for example, you only get so much treatment per year. And after several years, they’ll eventually cut off your insurance. This happened to film critic Roger Ebert, who wrote about how his insurance had cut him off, but he was lucky enough to have multiple insurance plans because of his previous jobs.
What does this mean for you?
Well, if you stay healthy the rest of your life, don’t develop allergies, eczema, high cholesterol, asthma, heart problems, joint issues, cancer or any other health condition — and don’t care about anyone among your family or friends who might get any of those conditions — then you might be fine under the Trump/Ryan plan.
If you ever get sick, however, in any way shape or form — or anyone you love ever gets sick — they’re in trouble.
The basic compact of insurance is that you buy insurance all your life, and for many years likely pay more into it than you get out, as a form of protection against coming down with something serious like cancer, or any surgery that might cost tends of thousands of dollars (appendicitis, for example, can cost $20,000 or more, and emergency room visits routinely cost sever thousand dollars for the most benign things). Insurance is a gamble — you pay into it, hoping that you’ll never need it.
Under Trump Ryan, you’re expected to pay more into insurance than you need when you’re healthy, then when you’re finally not healthy, they dump you and charge you even more.
But I thought the ACA only applied to poor people and people who work for themselves – nope.
One thing that I’ve found confusing in the Obamacare repeal coverage is the issue of who exactly benefits from Obamacare. Much of the reporting makes it sound like the ACA only applies to people in the “marketplace,” who tend to be people who work for themselves or are unemployed or in school. In fact, many of the ACA’s protections apply to everyone.
For example, the pre-existing conditions protection protects everyone, even those at a regular job. In the past, if you had a pre-existing condition and started a new job, you might have to wait a year before your new insurance would cover that condition. Now that’s no longer the case. Also, employers didn’t have to cover all the basic benefits, now they do.
But there’s another way the Trump/Ryan bill can affect people who don’t work for themselves, or otherwise currently have insurance. What if your status changes? Meaning, what if you lose your job? When I left the UN, I wasn’t allowed to get COBRA coverage, I had to go and buy my own insurance. Without the ACA, I likely would have been turned down because of too many pre-existing conditions.
Or what if you get your insurance through your spouse’s work, and you get a divorce or your spouse dies? Then what happens? Then, you may have to go get your own insurance, and the Obamacare protections will help you massively.
One final scenario. What if you move to another state? Insurance is state-based in the US. Meaning, if you currently have Blue Cross of Illinois and move to Washington, DC, you have to end your coverage with the Illinois company and buy new insurance with the entirely separate Blue Cross company in DC. And before Obamacare, the new company in the new state could deny you, or charge you a lot more, based on your pre-existing conditions. Effectively, you can never move to another state unless you have a job with a company, and even then, pre-ACA they might not cover your existing health problems for a year.
We must save the Affordable Care Act. We know what the world was like before the ACA, and while Obamacare has its problems, it’s a lot better than the dog-eat-dog insurance market we had before.
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