AKA Shel’s somewhat educated opinions on healthcare legislation


Last Monday I was privileged to represent the American Liver Foundation’s Hep C National Patient Advisory Committee as part of the Digestive Disease National Coalition’s (DDNC) Public Policy Forum and Hill Day. I met with staffers at 7 different Congressional offices (for Ohio and New Jersey), while they were all still waiting for a healthcare bill.

As someone with a preexisting condition, I feel prettystrongly about healthcare. I personally support the DDNC’s position regarding basic patient protections that are presently in the Affordable Care Act (ACA aka Obamacare). These are the protections the American Liver Foundation, DDNC, and I want to see maintained.

  1. Elimination of insurer discrimination against pre-existing conditions
  2. Establishment of out-of-pocket maximums for covered services
  3. Allowing young adults to remain on their parents’ insurance until the age of 26

You may say that these are all in the new “American Health Care Act of 2017“. Sure, but not in a way that lends itself to positive patient outcomes.

Here are some of the parts of the legislation that I find concerning:

  • Anyone with a gap in coverage of >2 months (for any reason) will have to pay a 30% premium surcharge.
    • My problem with this is that if someone went without insurance for 2+ months because they couldn’t afford it, they’re less likely to be able to afford to pay the 30% premium surcharge.
    • People will be willing to pay the surcharge if they know they *need* the insurance.  That means that there will likely be fewer people in the market for insurance (~2 million according to the Congressional Budget Office)
    • While technically this is not discrimination based on health status, the reality of it is that mostly those with pre-existing conditions will be willing to pay up. By the way, those people who are willing to pay up are also those who cost the most for insurers, essentially creating a high-risk pool of sorts. Health care providers will tell you that high-risk pools do not result in positive patient outcomes.
    • Also, please don’t tell me that people could enroll in Medicaid for the potential gap period. It takes *forever* to get Medicaid coverage. 
  • Older Americans can be charged up to 5x what the same plan would cost for younger Americans (vs. 3x in the ACA).
    • I have a similar problem with this one.  Older people often have less income, and the Congressional Budget Office has suggested that fewer older Americans would obtain coverage.
    • These are the folks that are more likely to need costly care.
  • Medicaid coverage is not required to cover mental health or addiction treatment under the American Health Care Act.
    • Seriously?!? These are the people that are likely to need it the most. Often addiction or mental illness will prevent someone from maintaining gainful employment, and makes those struggling with these to be likely to need Medicaid coverage.
  • The new tax credits are based on age and income. If you’re young and have a low income, you’ll get less of a credit than someone who is older with a low income.
    • The credit for older Americans is not 5x that for the younger person (roughly 2.5x), though, so older Americans will still have to come up with that big premium differential on their own.

Now, you might say “…but Shel, you’re not one of these people.”  You’d be right… *today*. Who’s to say about the future? It’s also not just about me. I know people who would fall into these categories. Chances are you do, too.

I’m not saying the ACA is perfect. There are obvious issues. As long as insurers are allowed to pull out because they’re not making as much money as they’d like (don’t kid yourself, they’re still making money), it’s not fiscally sound and there isn’t enough choice in the marketplace. All the basic patient protections I said I wanted, that pretty much everyone wants, are expensive. There are other problems, I’m sure. As per my disclaimer in the subtitle, I’m not an expert.

So back to my title point, don’t leave it up to Congress on their own. They don’t live in your reality or in the reality of your family and friends. Whatever your opinions, it’s most important to share them with your legislators. They need your input in order to represent you properly. Representing their constituents is their job. Call them, write them, fax them or e-mail them. Make sure they know what your concerns and viewpoints are.

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