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ACA Deathwatch: What “repeal” means to you

Here are questions you may want to ask about what a “repeal” and “replacement” will do.

  1. What will happen to your premiums?
    If more young people sign up, premiums for us older folks go down. If there is no mandate to buy insurance (and the continuous coverage requirement is far weaker than a mandate), insurance premiums for the 50+ crowd are going to go up – a lot. That’s because healthy seniors will decide the premiums are too high, so the only folks that will buy insurance will be the sick ones.  Insurers know this, so they will either a) exit the market; b) raise premiums to the moon; c) drastically limit coverage for specific medical conditions like heart disease or cancer; or d) go bankrupt.
  2. Is your medical condition still covered?
    ACA requires almost all insurance plans cover all physical and mental health conditions under the essential health benefits requirement. Replacement plans under consideration have no such requirements, allowing insurance companies to exclude specific types of treatment, specific conditions, types of providers, etc.
  3. Is addiction treatment covered?
    Currently mental health coverage is required for most employee and individual plans. Given the huge problems we face with opioid and crystal meth addiction, will a replacement plan require coverage for those seeking to end their addiction? Before ACA, about a third of individual insurance plans didn’t cover addiction treatment. And you can bet your house “replacement” insurance plans wouldn’t offer coverage…
  4. Can insurers limit coverage for medical diagnoses or conditions?
    Under ACA, there are NO lifetime or annual caps for specific medical conditions. The “replacement” plans allow insurers to set arbitrary caps for any diagnosis – cancer, heart disease, orthopedic injuries, or any other category they define.
  5. What happens if you lose your job and can’t afford to pay for individual health insurance while you are looking for work?
    Under the replacement plans, if you have a “gap in coverage” where you don’t have health insurance, when you apply for new coverage your insurer doesn’t have to cover your pre-existing medical conditions, and/or they can charge you higher rates.
  6. Who pays for emergency care for those without health insurance?
    Before ACA family insurance premiums included about $1000 for the additional cost of indigent care due to cost-shifting.  If the number of uninsureds grows – as it most certainly will – they will get care at hospital emergency rooms (hospitals are required to care for anyone presenting with emergent needs regardless of insurance status). So, this “hidden tax” will almost certainly increase your premiums.
  7. Will you be able to buy cheaper insurance from out-of-state health insurers?
    No.  There are three states that allow that today – and NO out-of-state insurers are selling across state lines.


7 thoughts on “ACA Deathwatch: What “repeal” means to you”

  1. Please keep at it Joe. The Washington Post is reporting today that a SuperPac backing Paul Ryan has begun running ads claiming the GOP has a replacement plan ready to go that doesn’t disrupt existing coverage. So the disinformation campaign has begun.

  2. It is a disgrace that in 2017 our Legislative leaders cannot ensure affordable healthcare for all. I am on COBRA as I was ill and had to leave my job. I am paying $1100.00/month. In getting estimates for an individual health plan as cobra comes to an end the quote I got for a individual policy which was $2,500.00/month, with higher deductables and higher out of pocket costs. That is not affordable. We all need to be viligant during these changing times and hold our elected officials accountable.

  3. Joe through out the ACA debate prior to passage and even now I have been baffled at the lack of understanding demonstrated by the insured public regarding the cost shifting that occurs when uninsured individuals go to the emergency room for treatment. My brother who is a suma cumlaude from Texas A and M has stated on numerous occasions the the reason the he is against ACA is because it supplements low income families with federal funding or expands medicaid. However he never acknowledges or understands that Health care premiums are affected when uninsured individuals go to the hospital and are unable to pay anything for the treatment. Obviously the hospital have to make this up some where usually by charging higher premiums to the insured. So in essence the public pays either way. The difference is that it is much cheaper to pay for a doctor visit in the doctors office rather than for the same visit in an emergency room. But so many people do not see it that way. He also feels that the mandate is not right but has no problem supporting an amendment to the constitution that would tell a woman what she can do with her body. It just gets crazier and crazier every day. Last night as I watch the President’s farewell address I was very proud and saddened of what I was seeing. For at least four years we are going to have a president that degrades the office and the republicans are to blame because ever since the President was elected in 2008 the republicans have done everything they could to degrade President Obama which in turn degraded to Office of President. It is a cycle I am afraid we my never pull out of. I know I am rambling but that is how I feel PTSD.

  4. In 2014 I left my job to start my own consulting firm. My Cobra premium was going to be $1,100 per month. Obamacare provided a premium for $325/month.
    Seniors on Medicare gained free preventive care and the prescription ‘doughnut hole’ was closed…all part of the Affordable Care Act.

  5. I’m in my 70’s and never thought I would ever witness such deplorable behaviors in this great land of ours.
    For the Republicans to put forth such a despicable and in-qualified man to represent them is mind boggling.

    They are soulless, as demonstrated by their attempt to dismantle the O.C.E. and now the charge is on to inflict cruelty and abandonment on the sick, the poor, hard-working Americans with pre-existing conditions, and the elderly.

    We must be ever vigilant for the next four years. Super PACS do not have any the daily challenges that face most Americans and clearly their agenda is to enrich their coffers, personally and professionally.

    Please inundate your Senators with phone blasts, attend or contribute to the Women’s March in D.C.,Saturday, January 21, 2017. If you can’t get to D.C., check your local State or City. I know Boston, San Francisco, Philly are marching and would guess NYC, as well. This march is about all Women’s Rights.

    “You preach a better sermon with your life than your lips” –

  6. Not a huge deal, but I have never agreed that prior to the ACA, insured persons were paying $1000 a year due to cost shifting for the uninsured.
    Per the Urban Institute, the total amount of EMTALA care that went unpaid was about $30 billion a year.
    Hospitals got some of this back from the DSH Medicare subsidies.

    At least 120 million persons have had private insurance. Divide 120 million by some number less than $30 billion, and you have a cost load under $250 apiece.

    1. Morning Bob – It’s more than EMTALA, however there are different views on this. Austin Frakt’s piece is worth reading.

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Joe Paduda is the principal of Health Strategy Associates



A national consulting firm specializing in managed care for workers’ compensation, group health and auto, and health care cost containment. We serve insurers, employers and health care providers.



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