What happens to Obamacare?: Prediction


For those of you who don't know, I frequently tell people that never in a million years did I ever think I would be in the health insurance business. What got me involved and keeps me involved today are stories that I hear from consumers. The following is a story about a lady named Linda.

I met Linda at a hospital event we held to help community residents understand their health insurance options through The Affordable Care Act and Healthcare.gov. Linda was shy and stood at the doorway hesitating to take that next step and talk to me. Luckily, Linda's daughter persuaded her to take a chance, telling her mother she had nothing to lose. Linda shared the story of her husband of 40 years who had contracted cancer. Linda cared for him for the final two years as he battled and ultimately succumbed to his diagnosis. Linda described her husband as someone who had taken care of all the financial responsibilities while she raised her children and managed the household. Her husband had a very good job with health insurance benefits for both himself and Linda. During the time Linda cared for her husband, she also got ill. I have read that many times caretakers, and perhaps even more strongly with spouses, to die along with the people they are caring for. Linda was certainly struggling with her own health- she had started to go blind in one eye while she battled diabetes and other illnesses. After her husband's passing, not only did Linda lose her soulmate of 40 years, but she also lost the health insurance plan under which she'd been covered through husband's job. Linda's health continued to deteriorate, and her daughter suggested going to the local health insurance enrollment event at the hospital.

After I heard Linda's story, I couldn't help but think to myself that prior to the passage of Obamacare, Linda essentially would be one of the people who had little to no hope of receiving the necessary treatment and care to fight her disease. As you know, people like Linda with a pre-existing condition would have been rejected for coverage. However, Obamacare changed that, and no longer could Linda be denied. We were able to qualify Linda for a tax credit enabling her to pay only $38/month for insurance. In addition, we found her a great plan allowing her to connect to the right doctors and receive medications she needed. It is stories like Linda's story that continues to fuel my desire to help people find affordable coverage.

Of course, affordability is the ultimate undoing of the law. Though tax credits have helped many people offset the dramatic increases in premium since 2013, others have felt the full brunt of the expense fall on their shoulders. In addition, for those who can't afford to pay , they may be assessed a tax penalty that seems unjust. I could go on and tell you the vital role the tax penalties play in insuring healthier risk pools, but at this point it's moot, as Republicans are now in control, and I foresee them changing this provision.

The question is, do the Republicans revert back to a system where people like Linda are shut out of access to insurance coverage simply because of her pre-existing condition? My answer to that is absolutely not, as the most recent repeal and replacement bill presented by House Republicans included a measure where insurance companies could not deny coverage because of a pre-existing condition. This at a minimum would open the door to coverage, but the question remains regarding whether it would be affordable for Linda? I recommend you read my post Just the Facts to further understand the enormity of the challenge.

With that said and after reading replacement proposals from Ben Carson, Jeb Bush, the Republican House, and what little I could make of Donald Trump's plan, I have come to the following predictions of what repeal and replace will look like.

1. The elimination of the individual mandate. This was a hotly contested provision that ultimately went to the Supreme Court and barely passed with a 5-4 vote with deciding vote Chief Justice John Roberts determining that the mandate was a tax, and such falls under the power of the federal government. (Update: this prediction came true as the individual mandate was eliminated starting in 2019)

2. Preservation of tax credits, but based on age rather than income. (This was passed by the house and fell short by one vote in the Senate)

3. Elimination of Qualified Health Plans. Consumers will be given the option to choose from a litany of options ranging from strictly catastrophic plans to platinum-level coverage. (True: the promotion of short-term plans, association plans and the elimination of the individual mandate provide more options for consumers.)(Opinion: This is fine as long as subsidies become available to everyone, irrespective of household income. See point#5)

4. The promotion of Health Savings Accounts by allowing people to divert tax credit dollars into HSAs in combination with catastrophic coverage. (There's a proposal to raise the contribution limits.)(I would like to see a tax credit created that matches contributions for households under $250,000)

5. They will attempt to manage pre-exiting conditions through the medicaid system with block grants from the federal government. (They tried this, but failed. My recommendation would be to cap household premiums at 10% of household income and provide federal subsidies for all costs above 10%).

6. Elimination of the employer mandate coupled with aggressive tax credits for small businesses.(Surprisingly, there's been little movement here)

7. The survival of Healthcare.gov to help individuals shop and sort through all of their options. (Healthcare.gov is still going strong)

Of course all of this is just an educated guess. But nonetheless, under any new system, the need for qualified brokers, agents & navigators to help people make the best decision for them and their families will continue to be vital to the success of getting people covered and making the law work. (Update:Navigator funding has been cut by 90%)


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