A Breakdown of Healthcare Proposed Changes

This week, the US Senate announced that they are going to postpone their recess in order to spend time reworking their healthcare bill, the Better Care Reconciliation Act.  Their goal is to reveal their updated bill Thursday (7/13/17), get a new score from the nonpartisan Congressional Budget Office a few days later, and vote on it next week.  Wow – those are some lofty goals.  It can be difficult to decipher the specifics of the bill without getting opinions from people on both ends of the political spectrum.  Since I haven’t seen the new proposal yet, here’s a breakdown of what’s potentially on the chopping block that matters for children, teens, and young adults (and other people too, obviously).

Essential Health Benefits

Prior to the passage of the Affordable Care Act (ACA), insurance companies were not required to cover certain “essential health benefits” (EHBs). Under the ACA, health plans sold to individuals and small groups (employers with 50 or fewer employees) must include these benefits:

  1. Emergency care
  2. Habilitative and rehabilitative services
  3. Inpatient care
  4. Outpatient care
  5. Maternity and newborn care
  6. Mental health and addiction treatment – just think how this could impact the opioid epidemic…
  7. Laboratory services
  8. Pediatric services, including oral and vision care.
  9. Prescription services
  10. Preventive services and chronic care treatment.

If the plans cover any EHBs, they cannot impose annual or lifetime limits on reimbursements for those expenses (important to people with pre-existing conditions). Eliminating the essential health benefits could affect almost everybody, including the millions of Americans who receive health coverage through their employers, since we could see the return of annual or lifetime caps.

The House GOP plan would eliminate the federal mandate under the ACA, and instead give states the power to determine what health plans sold on the individual and small group market must cover. The amendment proposed by Ted Cruz allows insurers to sell plans that don’t meet ACA requirements as long as they also sell plans that do meet ACA requirements. Insurers would be free to sell cheaper, bare-bones plans to young and healthy consumers who don’t think they’ll need certain benefits. Many of those consumers would end up paying less for their health insurance. But for people needing broader coverage, the change likely would mean higher premiums and fewer choices. It also would force people who opt for bare-bones coverage to pay out-of-pocket for services they unexpectedly need (and who really plans for a car accident or ruptured appendix?). This is important – since the implementation of the ACA, we have seen a sharp decrease in the amount of people filing for bankruptcy (by a whopping 50%!).

Changes to Medicaid

Medicaid covers 37 million kids in the United States (540,000 in Wisconsin).  Children living in or near poverty, children in foster care, and children with complex health care needs (even if their parents have private insurance) all depend on Medicaid. Through Medicaid, children are guaranteed benefits that cover a comprehensive array of medically necessary services.

The GOP bill dismantles the Medicaid program by capping its funding, ending expansion and allowing for scaling back of benefits. Starting in 2020, the bill limits federal Medicaid spending with per capita caps, or block grants for states that choose them. What does this mean, exactly? Current Medicaid federal funding responds to program needs, and federal funding is tied to state spending.  With this, there is guaranteed coverage if you meet the requirements, no wait list or caps.  If the needs of the state goes up (like West Virginia with their opioid epidemic), the funding goes up. With a per capita cap, each state gets a certain amount of federal money per enrollee, with no response to healthcare costs and needs. With a block grant, states receive a preset amount of federal dollars for their entire Medicaid program, and there is not an increase in funding with increased healthcare needs.  So if the state has a big recession and unemployment levels go up, there is no guarantee that people will be able to get on Medicaid. Or if there is a natural disaster or outbreak of a disease (see Puerto Rico’s issue with Medicaid after Zika virus), the people affected may be out of luck.  This is the reason that the hashtag #DontCapMyCare is trending on Twitter. Check out this article for a quick, easy read about these potential changes and their differences.

How would Medicaid cuts affect you if you have private insurance? Great question – I’m glad you asked. If Medicaid was cut, most children’s hospitals would see such a significant drop in their revenue that smaller hospitals would close and major institutions would be forced to scale back on the services they offer. Rural hospitals and clinics will also be severely impacted. These health care facilities depend on the Medicaid reimbursement from their patients – if the patients lose insurance, it does not mean that they lose the need for health care. Caring for the uninsured may be too expensive for these smaller institutions (who have less of a buffer than the larger institutions), and they could close altogether.  For more information on how these potential changes to healthcare impact small towns and rural communities, check out this site from Georgetown University.

Leave a Reply

Your email address will not be published. Required fields are marked *