If you have a preexisting medical condition, you will probably pay a lot more for health insurance next year.
If you are over the age of 60, it’s likely you’ll pay quite a bit more on your insurance premiums than someone younger than you.
If you’re young and healthy, you might be able to opt out of insurance altogether.
If you have insurance through your work, you might still discover that your insurance company no longer covers mammograms or gynecological services.
If Medicaid pays your medical bills, good luck.
And all of these potential health coverage issues will probably be more acute if you live in a state that supported President Donald Trump in last November’s election.
Those are some of the potential issues on a long list of complaints filed by critics after the House of Representatives on Thursday voted 217 to 213 to approve the Republican-sponsored American Health Care Act (AHCA).
The approval came six weeks after Republicans called off a vote on a similar healthcare plan because they didn’t have the votes to approve it.
The AHCA bill now goes to the Republican-controlled Senate, where it faces potential rewriting and changes.
President Trump has indicated he will sign the final measure.
Most of the AHCA will take effect next year.
Reaction is mostly negative
The passage of the AHCA was trumpeted by Republican leaders, who said the bill fulfills their promise to “repeal and replace” the Affordable Care Act (ACA) approved by Congress in 2010.
“We are all breathing a sigh of relief,” Rep. Chris Collins, R-N.Y., said. “We’re living up to a campaign promise we made, the Senate made, the president made.”
House Speaker Paul Ryan, R-Wis., said leaving Obamacare in place would have meant “even higher premiums, even fewer choices, even more insurance companies pulling out, even more uncertainty, and even more chaos.”
President Trump praised the bill after its passage.
“What we have is something very, very incredibly well-crafted,” the president said.
The reaction from organizations outside Washington, however, was mostly negative.
The conservative Citizens’ Council for Health Freedom (CCHF) said the AHCA is still “government-controlled healthcare.”
“The American Health Care Act is not repeal, and the American people wanted full repeal of Obamacare,” said Twila Brase, the president and co-founder of CCHF, in a statement.
Brase said states must ask for permission to change their healthcare systems. She added the AHCA does not guarantee lower costs or broader health coverage choices.
“The AHCA does not return health freedom to Americans,” Brase said. “It is essentially Obamacare without the taxes.”
The American Medical Association (AMA) was also quick to criticize the Republican plan.
“The bill passed by the House today will result in millions of Americans losing access to quality, affordable health insurance and those with preexisting health conditions face the possibility of going back to the time when insurers could charge them premiums that made access to coverage out of the question,” said Dr. Andrew W. Gurman, president of the AMA, in a statement.
Gurman added that action is still needed to fix the problems in the country’s health insurance system. He urged the Senate and the White House to come up with a bipartisan solution.
One of the major organizations representing the insurance industry also expressed the need to repair the House bill.
Marilyn Tavenner, president and chief executive officer of America’s Health Insurance Plans (AHIP), said her group wants to work with the Senate and others to make improvements.
“AHIP believes that every American deserves coverage and care that is affordable and accessible, including those with preexisting conditions,” Tavenner said in a statement. “The American Health Care Act needs important improvements to better protect low- and moderate-income families who rely on Medicaid or buy their own coverage.”
Other groups saw little good in the House bill.
“We are deeply disappointed in the result of today’s vote on the American Health Care Act (AHCA). Today, the sunny, flamboyant promises of better healthcare at a lower cost during a political campaign gave way to the cold, dark realities of politics in America,” said Paul Gionfriddo, president and chief executive officer of Mental Health America.
Officials at Public Citizen were equally harsh.
“The real-world consequences will be people dying from treatable illnesses, suffering needlessly, and entering into medically driven bankruptcies,” said Robert Weissman, president of Public Citizen, in a statement.
As were leaders at Doctors for America.
“This is terrible for the country. It’s terrible for doctors and patients. It’s terrible for anyone who needs healthcare,” Dr. Alice Chen, the executive director of Doctors for America, told Healthline.
What the new plan would do
In essence, the AHCA gives states the option to file for exemptions to provisions in the ACA.
One of the major exemptions would be the mandate that individuals purchase health insurance or face tax penalties.
The AHCA would allow states to dump that requirement. That means younger, healthy people could decide to go without insurance.
However, any person who goes without insurance for more than two months would be charged an additional 30 percent on their premiums if they signed up again. That penalty is in effect only for the first year of the legislation. The extra fee would be paid to insurance companies, not the government.
The bill would also allow states to drop regulations that required insurance companies to offer coverage to people with preexisting medical conditions. Under the measure, the states would need to set up high-risk pools where insurance companies could charge clients with preexisting conditions higher rates.
The bill provides $138 billion over 10 years to help subsidize premiums as well as pay for mental health and addiction services.
The AHCA also leaves in the ACA provision that young adults be allowed to stay on their parents’ insurance until they are 26.
The measure allows insurance companies to charge older customers up to five times more for coverage than they charge younger customers. ACA limited the increase on older customers to three times the younger customers’ rates.
The bill would also freeze Medicaid expansion in 2020 to the states and individuals who are already covered. It would cut an estimated $880 billion from the program for low-income medical patients over the following decade.
The AHCA also eliminates taxes on medical device manufacturers, indoor tanning, and so-called “Cadillac” insurance plans.
Republican leaders said these changes are necessary to bring down the cost of health coverage, and widen the variety of choices for consumers.
“Inaction is the worst thing we can do. There are people out there at risk of not having any coverage,” Rep. Brian Mast, R-Fla., said after a closed-door strategy meeting on Wednesday.
“The Affordable Care Act has left the individual market in shambles and has driven insurers away from offering coverage,” said Rep. Michael C. Burgess, R-Texas, on the House floor on Thursday.
Kurt Mosley, vice president of strategic alliances at Merritt Hawkins health consultants, has some concerns about the House plan.
But he also sees some steps in the right direction.
Mosley told Healthline he does see some merit in the high-risk pools. He notes such entities exist in the automobile insurance industry.
“Insurance companies have to charge people with preexisting conditions more,” he said.
The same is true for older adults, a group Mosley is part of.
“We use more health coverage,” he said. “I think that’s fair.”
He added that some of the changes will encourage more insurance firms to enter the marketplaces.
On the other hand, Mosley has reservations about the cuts in Medicaid.
“These are the people who need coverage the most,” he said.
He is also concerned the AHCA does nothing to combat the rising cost of prescription drugs and the growing opioid addiction crisis.
Mosley’s comments, though, are tame compared to others who spoke out on Thursday.
Concerns over coverage and costs
Critics of the ACHA say the elimination of the individual mandate and the creation of high-risk pools will cause insurance premiums to skyrocket for people with preexisting conditions.
They say these folks will either pay astronomical prices or decide to go without insurance.
When the initial House healthcare plan was unveiled earlier this year, the Congressional Budget Office (CBO) estimated it could cause 24 million Americans to lose insurance coverage by 2026.
CBO officials did not have time to come up with an estimate for the latest plan, but critics say the number of uninsured could be even higher, especially with the cuts to Medicaid programs.
“These effects will be felt mostly by people with chronic conditions, just as drivers who have accidents and homeowners with storm damage experience increases in their insurance premiums,” said Gionfriddo. “They will affect people with cancer and heart disease. They will affect millions with serious mental illnesses.”
“One of the worst things for a doctor,” added Chen, “is to look a patient in the eye and say you can’t get treatment.”
The American Association of Retired Persons (AARP) said the AHCA is in essence imposing an “age tax.”
They estimated the extra charges could increase annual premiums by $13,000.
The organization added that the changes could affect 25 million people aged 50 to 64 who have preexisting conditions such as cancer, heart disease, and diabetes.
The AARP and other groups also said the AHCA provision that allows states to exempt insurance companies from having to provide certain basic services could result in coverage being dropped for mammograms, gynecological services, emergency room visits, prescription drugs, and mental health services, even for people with insurance through their workplace.
“Driven by partisan extremism, blind ideology, and an almost genetic predisposition to cut taxes on the rich and big corporations, House Republicans don’t care about the impact of their vote on everyday Americans,” declared Weissman.
Finally, healthcare advocates predicted that people who live in rural America would end up getting hurt the most.
In addition, a recent study concluded that the death rate of white, working class Americans is rising more quickly than any other group.
The increase is mostly due to drug addiction, suicide, and chronic diseases.
“This bill picks winners and losers,” said Chen. “As a doctor, that’s just not acceptable to me.”