When the American Health Care Act passed the House of Representatives in early May, many senators vowed to give the bill a complete overhaul. The bill, which is often referred to as “Trumpcare,” caused a lot of outrage and fear, especially because the Congressional Budget Office projected that it would lead to 23 million people losing their health insurance by 2026.
Even though there are clearly many incredibly problematic things about this bill, most Americans are in the dark about where it stands. It hasn’t been in the news much lately, largely because Republican senators are working quickly to move it forward as secretly as possible. But the bill is still very much alive—and changes are being imposed that could have a serious impact on millions of Americans.
Now, a new report is calling attention to yet another disastrous component of the bill: It will allow insurers to impose annual and lifetime limits on coverage benefits. That means that, in addition to the potential 23 million people already projected to lose health insurance, this component of the bill could impact millions more—including people who get their health insurance from their employers, rather than from the exchanges or through Medicaid. Got that? If you think the ACHA won’t affect you because you don’t get your insurance through the Obamacare exchanges in the first place, you’re wrong.
According to New York magazine, like the version that passed in the House, the Senate’s health care bill will allow states to opt out of the Affordable Care Act’s essential health benefits requirements. Meaning, insurance companies will no longer automatically be required to cover things like maternity care, mental health, preventative care, and rehabilitation services if states determine that they’re not necessary. What’s more, they’ll be able to impose lifetime and annual limits on health care coverage, which could screw over millions of Americans.
Health care can be complicated to understand, especially when so many things are in flux. Here’s what you need to know.
Health care expert Caitlin Donovan, spokeswoman for the National Patient Advocate Foundation, tells SELF that these are a dollar amount after which insurers can stop paying for covered benefits during the time you’re enrolled in that plan. Under the Affordable Care Act (“Obamacare”), lifetime limits or annual limits (same concept, just over the span of a year) were illegal, but only in the case of essential health benefits. “If you get rid of the essential health benefits, you get rid of the caps,” says Donovan.
While the argument is that allowing insurers to cut some of these essential health benefits will result in lower premiums, Donovan points out that the move will likely have “very real implications for the entire population way beyond potentially lower premiums for a lucky few.”
This news could affect people with large group employer coverage, aka a group health plan that covers people working for a company with 51 or more employees, in a surprising way. Employers with a presence in multiple states could choose the state in which they base their coverage, Donovan says. Then, that state’s decision to, for instance, waive essential health benefits would affect employees in all states, not just those who are physically residing in the state.
“And so, voilà—get rid of essential benefits, and all of a sudden a woman in New Jersey with a complicated pregnancy and delivery could be faced without any medical coverage…because of the decision of a governor thousands of miles away in state in which she does not live,” Donovan says.
It’s easy to think you’d never work for a company that would willingly put the health and lives of its employers at risk in this way, but unfortunately, more companies than you might think are interested in making this switch. A recent survey of 666 large employers by Willis Towers Watson found that 20 percent of companies said they agreed or strongly agreed that they would impose annual limits on coverage if essential health benefits were removed, while 15 percent said the same for lifetime limits.
Based on that and census data, the Center for American Progress ran some numbers and projected that 27 million Americans with employer-based coverage would face annual limits if the Senate bill passes, and 20 million would face lifetime caps.
People with issues like heart disease or cancer, or those who are at risk of developing them (i.e., pretty much everyone) stand to lose the most, Leonard Fleck, Ph.D., a professor of philosophy and medical ethics at Michigan State University, tells SELF. And things can get really bad, really fast. Dr. Fleck cites an example of a healthy man he knew who needed gallbladder surgery and had a $1.5 million lifetime cap on his health insurance. The man had one complication after another from his surgery, mostly from hospital-based infections, and ended up with a $2.5 million bill.
Dr. Fleck says that annual and lifetime limits are especially controversial because they target something that few people would know about themselves right now—many people have no idea whether they’ll have a complicated pregnancy down the road or develop cancer. The idea of an annual or lifetime limit is just a concept for most people, who probably think they won’t ever be in danger of running up against it. That’s good for politicians who want to get this bill passed. “That avoids alienating individuals who believe themselves to be healthy or who have no idea how easy it is today to hit a lifetime limit of $1 million,” he says.
Sarah O’Leary, founder of Exhale Healthcare Advocates, a national consumer health care advocacy group, tells SELF that annual and lifetime limits only benefit insurance companies, not patients. “It is a horrific idea for Americans,” she says.
Naturally, you’d expect that this would be openly discussed like the AHCA was when it was with the House, but the Los Angeles Times reports that Republican senators are trying to use underhanded tactics to move the bill along. According to the L.A. Times, while people were closely following the recent testimony of former FBI Director James Comey, Senate Majority Leader Mitch McConnell invoked Senate Rule 14, which lets a bill bypass a committee—meaning, there are no hearings and no debate—and be brought to the Senate floor for a vote. That increases the odds that the bill, which has been hugely unpopular with Americans, will be brought to a vote before the Senate goes on recess in August.
Fleck calls this move “ethically and democratically despicable” and O’Leary agrees.
If you’re upset about this news, you have a right to be—and to voice your concerns. Here’s exactly how to contact Congress and get your point across.
Watch: “I Have a Pre-Existing Condition”: Real People Share Their Health Conditions in Response to the AHCA
Source Article from http://www.self.com/story/ahca-lifetime-annual-limits