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Countable Q&A: The GOP Healthcare Bill

by Countable | 5.10.17

There has been a lot of confusion surrounding the Republicans’ bill to repeal and replace Obamacare, so in an effort to bring some clarity to the debate we’ve answered some of your questions about the American Health Care Act (AHCA) below.

I am hearing that pre-existing conditions are back and that if you lose your insurance and don't re-enroll there is a penalty when you do sign up. Is this true? Please explain. — Jean L.

The Affordable Care Act’s (ACA or Obamacare) ban on denying health insurance coverage because of pre-existing conditions remains in effect under the AHCA. What the AHCA does is let states apply for a 10-year waiver from parts of Obamacare, like the essential health benefits mandate that requires health insurance plans to cover things like maternity care and mental health treatment. States that get a waiver would then be able to create their own essential health benefits standard, but health insurers would still be required to offer coverage to people with pre-existing conditions. Individuals with pre-existing conditions could only be charged higher premiums if they fail to maintain continuous health insurance coverage.

Where in the AHCA bill does it mention pre-existing conditions? I've seen articles saying they won't be covered, but having trouble deciphering where it says that in the bill. — Deb T.

Section 137(b) of the AHCA addresses pre-existing conditions, saying "Nothing in this Act shall be construed as permitting health insurance issuers to limit access to health coverage for individuals with preexisting conditions." It can be found at the bottom of page 91 of this PDF of the bill text.

As it is now written, would the AHCA affect Medicare? — Kathleen P.

The only changes the AHCA would make to Medicare both involve the tax code, no other reforms are included. An additional Medicare payroll tax of 0.9 percent imposed on taxpayers earning more than $125,000 as individuals or $250,000 for couples (in addition to the standard 2.9 percent payroll tax) would be repealed starting in 2023, and a tax deduction for expenses incurred under Medicare Part D would remain in place.

How can / will the AHCA affect those with insurance through their employers? — Allison

While the AHCA repeals Obamacare’s employer mandate — which requires businesses with more than 50 employees to offer health insurance to those working 30 hours or more per week or pay a tax penalty — it isn’t expected to cause most employers that currently offer plans to stop per the Kaiser Family Foundation. To the extent that states get and use waivers to change their definition of essential health benefits, that could impact the insurance plans employees get through their work and what is covered by the plan.

Did or did not the AHCA bill passed by the House include a clause to exempt members of Congress and their staff from pre-existing conditions etc.? I know originally it did include an exemption, but days prior to the vote an amendment was introduced by an Arizona rep. that disallowed this exemption and was passed. Which was one of the stepping stones to get it pushed thru. Is this not correct — Evelyn S.

The AHCA does contain a provision that exempts members of Congress and their staff from state waivers of Obamacare requirements like the essential health benefits mandate, but Congress is already moving to end that exemption. Rep. Martha McSally (R-AZ) introduced a separate bill to end that exemption, which the House passed 425-0 the same day it passed the AHCA. McSally’s legislation couldn’t be introduced as an amendment to the AHCA itself because of the Senate’s Byrd rule, which prohibits the upper chamber from considering an "extraneous matter" in a reconciliation bill. Had it been tacked on as an amendment to the AHCA by the House, senators could’ve raised a point of order against it, which could have led to the bill needing 60 votes rather than a simple majority to pass the Senate.

Does the AHCA do anything to cut actual health care costs? Does it reduce unnecessary requirements that increase the cost of health care? Does it reduce frivolous lawsuits that drive up malpractice insurance and cause doctors to order unnecessary procedures so they do not get sued? Does it recommend processes such as a national medical database to improve efficiencies? My point being if we are not doing anything to reduce costs and improve efficiencies then all this other stuff is just moving costs around. Thank you. — Joe W.

Why don't they just enable the insurance companies to sale across state lines? — Keely

The questions raised by Joe and Keely are also related to the Byrd rule, in that it restricts what legislative items Republicans can include in the AHCA itself. GOP lawmakers have spoken of a three-pronged approach to repealing and replacing Obamacare that includes regulatory action, passing the AHCA through the reconciliation process, and additional legislation.

The House has already started bringing up those additional "phase three" bills for a vote, passing legislation to let small businesses form associations for buying health insurance, ending the health insurance industry’s exemption from antitrust law, and clarifying that stop-loss insurance isn’t health insurance. Expect more bills of that nature to get a vote in the weeks and months to come.

Will the ACA remain in effect in its entirety until the final AHCA is passed? Will everyone who is paying premiums under the ACA automatically transfer into an AHCA program? Will the Senate version be scrutinized by a financial review agency prior to a vote? — Janet S.

A broad repeal of Obamacare will only occur with the passage of the AHCA, and while Congress could theoretically undo individual parts of it in the meantime, they’ve been focused on the AHCA. The process for enrolling in a health insurance plan would be essentially unchanged, so people would need to sign up for insurance during an open enrollment period. It’s too early to tell if the Senate’s potential rewrite of the AHCA will be scored by the Congressional Budget Office prior to a vote, but it’s worth noting that the Senate’s action won’t be the last, as the AHCA will likely head to conference committee to resolve differences between the House and Senate versions. The conference report, as the final product is called, will almost certainly be scored prior to a vote.

Up until what age will children be covered under a parent’s plan under the AHCA vs current ACA? — Susan B.

The AHCA doesn’t change Obamacare’s requirement that children be allowed to remain on a parent’s health insurance plan until they turn 26 years old.

Don't see your question answered here? Well don't worry, we'll be responding to more of your questions in an upcoming post so send them our way!

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— Eric Revell

(Photo Credit: Office of the Speaker / Public Domain)

Countable

Written by Countable

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(146)
  • Abbi
    05/10/2017
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    It seems to me the ACA would have been fine if they checked the unbridled greed of insurance and pharmaceutical companies.

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  • Jane
    05/10/2017
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    From this day forward, anything and I mean ANYTHING, good or bad, that starts from Donald Trump that my Congress People support will be a black mark against them. I simply cannot vote for any one person that supports one thing from this disgraceful, disgusting hoax sitting, ( on rare occasion) in the Oval Office. You have all, by either your voting record or by a lackadaisical attitude, allowed the dumbing down of the once greatest nation on earth. You know he must be stopped but yet do nothing to stop him or the reprehensible actions coming out of the White House. Our government is in a shambles while you sit idly by. I'm embarrassed by all of you.

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  • JoshieVersace
    05/10/2017
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    Give us a universal or single payer healthcare system like every other modern 21st century thinking country already. What's really the deal here?

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  • Ellen
    05/10/2017
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    No changes until trump and his henchmen are gone

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  • Jennifer
    05/10/2017
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    The passage of this bill will bankrupt oklahoma citizens. Support of this bill does not represent the will of our citizens. I do not support it, and cannot support any representative of government that does.

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  • Brie
    05/10/2017
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    I live in OK, where our governor and legislature have done everything possible to resist any possible benefits from the ACA. Are you in the same situation? Because anyone thinks for one second that the same Republican governors and Republican state legislatures that opted out of expanding Medicaid and refused to build state level exchange under the ACA WON'T immediately file for a waiver to strip protections for people with pre-existing conditions, along with ACA requirements for essential services, then I have some waterfront property to sell you. In Kansas. Our members of Congress are well aware of this. They are equally aware that if THEY stripped those protections in the AHCA that a) they wouldn't have been able to get the votes to pass the bill and b) could have a tough time getting new-elected or at least might actually have to pay attention to their constituents. This way, they got their horrendous legislation past the House, can say that THEY aren't the ones that price millions of people with pre-existing conditions out of the market, but rather that it was the STATES. It's a way to get exactly what they want without having the intestinal fortitude to do it themselves. Don't fall for this shell game; stay on your members of Congress, let them know that you are watching, and that what they are trying to do is not OK. The end result will be the same. Millions of people will lose coverage because they can't afford coverage through the high-risk pools states will dump them into after they get waivers. Millions of our most vulnerable citizens who depend on Medicaid for coverage will find themselves uncovered because of cuts to Medicaid. I am not being melodramatic when I say that people will die. I am likely to be one of them. But thank God, this legislation gives the wealthiest citizens another tax cut, because how else could those folks make it? This is disgusting.

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  • Shana
    05/10/2017
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    As a nurse in rural Missouri and mother of Type 1 diabetic I fear for the lives of those with pre-existing conditions especially those that should have been covered under the a Medicaid expansion my state declined for its residents. I fear rural hospitals closing and making access even more difficult. We as Americans deserve single payor healthcare. We will get what we settle for folks so let's fight for our children and their future.

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  • Robert
    05/10/2017
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    Only a sick SOB would claim talking away people's healthcare would be a good thing like Tom Price recently did

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  • JayinNC
    05/10/2017
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    I hate trump , Ryan, and their heath care bill you have managed to hurt more people than all of ww2 we will remember this. Say good by to your jobs ass holes

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  • Neal
    05/10/2017
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    I don't support this! This is an insult to America and ANYONE in the house that supported this needs to be replaced IMMEDIATELY!

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  • Joy
    05/10/2017
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    The people that have health care for the first time still need the ACA. Women need what it offered for the first time ever and still do. If the GOP vote away our health care we are not going to be happy. And there are a lot of us that vote!

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  • Matthew
    05/11/2017
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    Keep the Affordable Care Act!!! Dump the inferior and inhumane ACHA. Show the American people you have a heart. Show that you actually care about your fellow Americans--the people you represent. DO NOT repeal and replace the ACA with GrimReaperCare or TrumpCare.

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  • Elizabeth
    05/11/2017
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    Give the American people universal health care. This would be the problem solver for the country.

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  • Candice
    05/11/2017
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    I am absolutely against the AHCA. People with pre-existing conditions will absolutely lose coverage if it is passed. Even the ones with private insurance. Often, when you have a major medical problem, such as cancer or a heart attack, you have to stop working. Since an interruption in coverage means that you lose all protections, we will be basically killing people. I've had Psoriatic Arthritis since my 20's. When I'm on my meds, you'd never know I was sick. When my meds are interrupted, I can't type, cook my own food, or hold my dog's leash. I'd be disabled. Doesn't it make more sense to keep me healthy?

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  • R
    05/10/2017
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    Obama care is bankrupting the citizens of this country! My premiums have tripled while my deductible has double since it's passage. Creating competition in the marketplace would be a great start!

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  • Chris
    05/11/2017
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    The republicans can pass their garbage on the people but exempt themselves!!! Leave Obama care alone, fix what's wrong with it.

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  • Jeffrey
    05/11/2017
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    No no no!!!!!

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  • Megan
    05/11/2017
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    This bill sucks. Fix what's wrong with the ACA, but don't get rid of it.

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  • Richard
    05/11/2017
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    Yes, single payer.

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  • Dorothy
    05/11/2017
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    Stop pretending like Donald Trump is normal. The truth will come out eventually. As New Mexico's congressman you will go down in history as supporting Mr. Trump or not. Mr. Pearce please be an American and not a politician. Stop trying to get as any republican bills passed as possible. Stop taking from the poor to give back to the rich. Stop lining your own pocket book at the expense of your constituents.

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