Since Senate Republicans released the draft of their bill to repeal and replace the Affordable Care Act last week, many people have been wondering how the proposed changes will affect their own coverage, and their family’s: Will my pre-existing condition be covered? Will my premiums go up or down?
The bill is still a work in progress, but we’ve taken a sampling of questions from All Things Considered listeners and answered them, based on what we know now.
Q: My husband and I are both in our 50s, self-employed, and we have a daughter in college. We buy insurance through the California exchange. Our family premium is now $1,100 a month with a deductible of $6,800 per person. We have never received a subsidy.
Three months ago, I was diagnosed with breast cancer. It was early stage, and I am in treatment with no cancer remaining. We are all very active and healthy otherwise.
Here is my concern: Based on what I have read, it appears our age group stands to see the biggest jump in premium costs. Not to mention, I now have a pre-existing condition. Will our premiums rise astronomically?
— Denise Estrada, Los Angeles, Calif.
A: This is a double-barreled question on premium costs and pre-existing conditions, both major concerns to consumers.
For a person in their 50s, worries about premium increases are well-founded. Under the Affordable Care Act, insurance companies are allowed to charge older people up to three times more than young people for the same insurance policies.
The Republican health care bills in both the Senate and House would allow insurers to charge up to five times more.
That change would likely lead to cheaper health plans for younger people, but also more expensive ones for those over 50. The Kaiser Family Foundation estimates that a 60-year-old in Los Angeles County who doesn’t qualify for subsidies would see her premium rise about $2,600 a year.
As for your question about your pre-existing condition, the answer would depend on where you live. The Senate bill does preserve the pre-existing condition protections that exist under the Affordable Care Act — meaning insurance companies must offer you a policy even if you have a medical problem. But it would also allow states to ask for waivers from some federal regulations, including those that define “essential health benefits.” If a state doesn’t include cancer treatment or pharmaceutical coverage in those benefits, then insurance companies can elect not to pay for some of the care you need.
Q: My 2 1/2-year-old son has been through eight hospitalizations and is fed partly through a feeding tube. We have insurance through my husband’s employer, and our son qualified for Medicaid last November because of a program in Pennsylvania for children with chronic illnesses.
The medical bills we’ve already seen would have been catastrophic without insurance, and our out-of-pocket medical expenses were thousands of dollars a year, even with insurance, before he qualified for Medicaid. His medical care needs have been so intense that I have not been able to work this past year.
We are very worried about his future care costs without Medicaid, as well as our ability to afford insurance coverage for him if pre-existing conditions are not afforded any legal protections.
How is Trumpcare likely to affect our family?
— Emily Kane, Pittsburgh, Pa.
A: It sounds like Pennsylvania’s Medicaid program has been helpful for your child. Under the proposed law, states will have even more power to design their own Medicaid programs, so there’s no reason to think that Pennsylvania would take away a local program that it has implemented.
What might be worrisome, however, are the overall reductions to the Medicaid program. The bill turns Medicaid from an open-ended program that pays for all the care beneficiaries need, to one that caps federal spending based on the number of people enrolled. The Congressional Budget Office predicts that if the Senate bill passes, Medicaid spending would be 26 percent lower, over the next decade, than it would be under the Affordable Care Act.
Some analysts believe that over time, states will have to cut services, reduce how much they pay doctors and hospitals and make it harder to qualify for Medicaid.
Q: My wife and I are both 42, and we have two children, ages 10 and 13. We have coverage through the marketplace but do not qualify for payment assistance. In addition, my wife has rheumatoid arthritis and currently uses expensive monthly injections to treat it. Would insurance still be required to cover my wife’s arthritis treatment under the new law? And how would our premiums be affected?
— Jeremy Merrill, Cedar Park, Texas
A: As far as premiums go, it looks like yours are likely to remain about the same. The Kaiser Family Foundation estimates that for a 40-year-old in Williamson County, Texas, who doesn’t qualify for subsidies, premiums are flat under the new law.
Whether your insurance will cover your wife’s condition depends largely on your governor. As I explained above, states can ask for waivers from many of the Affordable Care Act’s consumer protections, including those that define what medical services insurers have to cover.
Q: My 16-year-old daughter has Crohn’s disease. She requires Remicade infusions every six weeks. Each infusion costs $20,000. I am very concerned about lifetime maximums being reinstated. Additionally, I worry that children will no longer be able to stay on their parents’ insurance policies until 26, and that pre-existing conditions will result in higher premiums, even for employer-sponsored plans.
— Amy Lowe, Dayton, Ohio
A: You only have to worry about one of those things.
The Senate bill does include the very popular provision in the Affordable Care Act that allows children to stay on their parents’ health insurance policy until they are 26.
However, there is a chance that lifetime spending limits and annual limits [to what an insurer would pay for the care of a given patient] could return. Before the Affordable Care Act, about 60 percent of employers had lifetime limits on their health plans. The section of the bill that allows states to get waivers from federal rules opens the door to those limits making a comeback — even in employer-sponsored policies.