There’s been lots of bluster about repealing and replacing the Affordable Care Act since the day it was enacted. The reality of actually doing it is apparently turning out to be a bit more . . . um . . . complicated than anticipated. This week Senator Rand Paul engaged in a little theater with the Great Health Care Bill Hunt. It seems that either Republicans are being ridiculously secretive about what’s in the works – even with members of their own party – or there’s no viable legislation available to share.
In either case, the big talk without concrete details is making people nervous. The best guess of what proposed legislation would look like is Paul Ryan’s plan put forward in June 2016. This plan would, among other things:
- Remove individual mandates to have coverage, but continue to prohibit insurers from denying coverage based on pre-existing conditions. Without an individual mandate, premium costs are likely to increase dramatically because insurers are covering more sick people and therefore have more costs which they will need to pass on. Or insurers will just bail and people will lose coverage entirely.
- Provide a flat, age-adjusted tax credit for those without coverage through an employer, Medicare, or Medicaid. Flat means you get the same amount regardless of your income unlike the ACA where credits were paid on a sliding scale. So if my income is $1000 a month and your income is $4000 a month and we need to buy insurance that will cost us $300 a month we both get the same amount of credit.
- Repeal ACA cost sharing subsidies that reduced deductibles, copays, and out-of-pocket limits for qualified households. So not only do you and I get the same amount of help with paying for premiums, but we also have the same deductibles, copays, and out-of-pocket limits despite our vastly different income.
- Push the use of high deductible health plans. These plans have cheaper monthly payments, but require that you pay a lot up front when you need care. Payments for out of network services do not count toward that deductible. In 2017 the minimum annual deductible for high deductible plans is $1300 for an individual and $2600 for family coverage. The maximum annual out of pocket expense is $6,550 for individuals and $13,100 for families.
- Push the use of health savings accounts. You put money in your account pretax and then draw on it for copays and other approved expenses. What expenses would qualify under Ryan’s plan isn’t clear. In 2017 the maximum annual contribution to a health savings account is $3400 for an individual and $6750 for a family so you better hope your expenses aren’t any more than that.
There are also lots of changes to both Medicare and Medicaid proposed that deserve individual posts of their own.
And because it is #justthefactsfriday and I don’t know everything, corrections, additions, and conversation are welcome.