Republicans have reached a milestone in their years-long quest to overhaul the Affordable Care Act, commonly known as Obamacare.
On Thursday, members of the U.S. House of Representatives voted in favor of a revised version of the Republicans’ health care reform bill, known as the American Health Care Act. This version of the bill reflects several amendments made since Republicans tried to advance the proposed legislation in the House two months ago.
The American Health Care Act must also make it through the U.S. Senate before it can be advanced to President Donald Trump’s desk. But if it reaches his desk and is signed it into law, you can expect the bill’s recent amendments to affect American pocketbooks. Here are two big impacts it might have:
1. The bill changes rules for those with pre-existing conditions
Under current law as well as the prior version of the GOP’s American Health Care Act, health insurance companies are prohibited from denying coverage or charging more money to a patient because the patient has pre-existing health conditions. But the new legislation’s MacArthur Amendment changes that somewhat.
Named for the congressman behind it, Rep. Tom MacArthur, R-N.J., the amendment gives states the choice of effectively opting out of the pre-existing conditions prohibition and devising their own alternatives. As the New York Times has summarized it:
“Insurers would be allowed to charge higher prices to sick customers who had experienced a lapse in coverage of more than 63 days, as long as the state also set up a program to help high-risk patients obtain insurance.”
However, the House Republicans’ website about the American Health Care Act says that “in states with a waiver, individuals who maintain continuous coverage could not be rated based on health status.” So if your state opted to devise its own program for patients with pre-existing conditions, you would want to be especially sure to maintain continuous health care coverage if you have pre-existing conditions.
If you do experience a lapse in coverage, though, the Upton-Long Amendment (from Reps. Fred Upton, R-Mich., and Billy Long, R-Mo.) might help you. It sets aside $8 billion to reduce the premiums and other out-of-pocket expenses of patients with pre-existing conditions who have a lapse in coverage and who live in a state that set up its own program for patients with pre-existing conditions.
In addition, the higher rates can only be in effect for one year. Once an individual retains coverage for 12 months, they return to the standard rate.
2. The bill allows states to craft their own ‘essential health benefits’
Under Obamacare, health insurance plans must cover what are known as “essential health benefits.” These 10 categories of benefits include hospitalizations, prescription drugs, mental health disorder services, maternity coverage and pediatric services.
Under the current version of the Republicans’ health care reform bill, those 10 benefits remain the federal standard. But the MacArthur Amendment gives states the choice of effectively opting out of the standard and devising their own alternatives.
This amendment treats the essential health benefits requirement similarly to the pre-existing conditions prohibition. States that wish to opt out must first publicly attest that they’re doing so because it would reduce the cost of health care coverage and increase the number of people with coverage. Additionally, states must specify which benefits they would require instead of the federal standard.
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