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Here are some basics to keep up with proposed changes in health care bill

May 15th, 2017 | Posted in Consumer Focus, Insurance Coverage

The American Health Care Act (AHCA) is revived and headed to the Senate. You know it could dramatically impact your life and those of patients. But what’s in it really?

Here are some basics of what’s in the bill and how you can find out more about it:

  • It is much like the bill rejected in March, but with some key changes. After a failed attempt to repeal and replace the Affordable Care Act (ACA), also known as Obamacare, the GOP amended and passed the AHCA in the House of Representatives 217-213 on May 4 after a dramatic late push that changed key votes.

Two Republican holdouts, Fred Upton, R-Mich., and Billy Long, R-Mo., switched to “Yes” votes after Upton introduced an amendment adding $8 billion to the fund for state risk pools, which Upton and other Republicans claimed would provide protection to beneficiaries with pre-existing conditions, an issue that had cost the bill support previously.

This was decisive because “[Upton] carries a lot of weight with [GOP] moderates” who had been hanging back from the bill, said John F. Williams, former press secretary for the House Committee on Government Reform and Oversight and former member of the Republican Senior Communications Staff Committee, now with law firm Hall, Render, Killian, Heath & Lyman in Washington, D.C.

Democrats contended that increasing funds for the risk pools was no substitute for a clear prohibition against refusing coverage based on pre-existing conditions, which the AHCA lacks. Senate minority leader Chuck Schumer, D-N.Y., compared it to “administering cough medicine to someone with stage 4 cancer.” Multiple industry groups, including the AMA and the American Hospital Association, opposed the amended bill, in part or in whole.

“Those with pre-existing health conditions face the possibility of going back to the time when insurers could charge them premiums that made access to coverage out of the question,” said the AMA in a statement.

“While it’s unclear what the next steps will be as it relates to repeal, replace and repair – and how it might be revised and revisited – we call on the Senate to reset the discussion,” said outgoing AHA President Rick Pollack in opening the hospital group’s annual meeting on May 8, according to an AHA statement.

Incoming AHA President Gene Woods noted that health care faces many challenges right now, and “we absolutely must fight to protect and expand access and coverage for our friends, families, and neighbors. There are some who seek to do the opposite — to roll back the gains that have been made. But without access to coverage and care, the health and lives of millions of our fellow Americans may be jeopardized.”

  • There is no list of pre-existing conditions in the bill itself. There is language in one of the newly added amendments that would allow states to seek a waiver allowing insurers to consider pre-existing conditions when setting premiums. That, say critics, effectively would allow insurers in those states to raise premiums for certain pre-existing conditions for certain time periods as happened before Obamacare went into effect.

While the bill itself is more than 130 pages long, it is a legal document that largely discusses the various sections that are to be repealed and/or replaced in the almost 1,000-page Affordable Care Act. The Congressional Research Service (CRS) offers a more plain-language, 72-page analysis of the GOP bill and how it compares to the ACA.

The CRS works exclusively for Congress, “providing policy and legal analysis to committees and members of both the House and Senate, regardless of party affiliation,” according to its website.

  • What happens next is up to the Senate. In the House, no Democrats voted for the bill and 20 Republicans voted against it. The bill now goes to the Senate, led by Senate Majority Leader Mitch McConnell (R-Ky.) Several senators have indicated there may be a substantial revision of the bill or that a new bill may be put forward all together. Changes would have to be worked out in conference.

Whatever the legislation becomes, if it is passed and becomes law, it is still likely that consumers will not feel the impact immediately.

As with the uncertainty over health care insurance shortly after the election, patient advocates and others recommend keeping up with the changes.

Although your local congressman or senator should be able to provide information, there also are a couple of other ways to track the bill and find out what’s in it.

Also, there are several places you can go to check out rumors that may be circulating. For instance, Kaiser Health News published a roundup of fact-check articles published shortly after the AHCA was passed in early May.

For those websites and more see below. — A.J. Plunkett (aplunkett@decisionhealth.com) and Roy Edroso (redroso@decisionhealth.com).

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