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American Health Care Act – AHCA: what can we expect?

  • June 23, 2017
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American Health Care Act – AHCA: what can we expect?

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The Senate’s version of the American Health Care Act is likely to be revealed Thursday. Here’s an insider’s look…

The Senate version of the AHCA is to be released sometime today.

As information is made available I will share for your review, preliminary reports state there are few “major” changes to the House version. We do know that changes are being made to Medicaid and the subsidies that allow many to pay for their coverage are being reduced. It is also stated that the individual
mandate – have to have coverage – has been removed.

Medicaid is the largest health care program in the country, higher than Medicare. It covers most of the health care in the US offered by the government – half of all births, in California 50% of kids are covered, covers the long term care for 2/3 of Americans living in nursing homes, etc. If the Senate version follows the House version of the American Health Care Act (AHCA) than it is likely to be a block grant or capped.

Under ACA Medicaid was expanded and now allows adults below 138% of federal poverty level – FLP to have coverage. This is the largest number of people covered under ACA. The proposed caps will be the funding for
Medicaid which will be based on a formula – the formula would determine a maximum payment for each person enrolled and would grow by a determined rate each year. It is expected it would not fully covered all the enrollees and/or the rise in health care costs. Additionally, unlike now the states would have to provide more funding to cover all the enrollees, this year ACA provides 95% of the funding for Medicaid.

As to the exchanges, the insurance subsidies are likely to be less and this uncertainty is what is causing insurance plans to leave existing exchanges, how can one run a business without knowing what the costs
are or likely to be? Additionally, the reduction of subsidies will also affect who is in the pool.
According to the Commonwealth Fund, pre-existing conditions affect over 60% of Americans. The researchers found that between 2013 and 2015, 2.6 million non-elderly adults out of the 16.5 million who gained insurance
had preexisting conditions that, in pre-ACA days, could have effectively locked them out of coverage because of insurers’ discriminatory denials and pricing. Another 9.4 million people had health conditions that could have increased their insurance costs. It is also thought health plans will be again offering “junk insurance” – low cost but covers few benefits, which become visible when you need to access care. Under the ACA there are 10 essential benefits that a health plan has to cover.

The CBO estimated that over 23 million people would lose coverage under the House version of the AHCA and under ACA over 20 million were able to get coverage.

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