Your Questions about the American Health Care Act

What does the American Health Care Act (AHCA) do?

The current health care law has created a failed system. Premiums are skyrocketing, deductibles are soaring and choices are dwindling.  In South Dakota, 100% of plans on healthcare.gov last year saw double-digit increases. Even if families manage to pay the increased premiums, many can’t afford the deductibles to use the insurance they have. And it’s only getting worse.

Repealing Obamacare is the first step in delivering relief, but we can’t leave it there. Health care is personal, which is why I’ve fought so hard to put health care decisions in YOUR hands, not the government’s. Ultimately, that’s what AHCA does.

With Obamacare’s taxes and mandates repealed, AHCA replaces the current system with new safety nets. It offers a new tax credit, gives states additional resources to help folks out, and enhances Health Savings Accounts to grant patients more flexibility. Those with pre-existing conditions will remain protected and young people can stay on their parents’ insurance until 26.

How will AHCA impact health coverage in America?

The independent Mercatus Institute found coverage is likely to decline even if Obamacare stays in place. They explain that in the coming years, some areas – and potentially entire states – will have no exchange-based coverage, as insurers will have completely pulled out. We’ve seen the beginnings of this already in South Dakota where the number of insurers offering options on the individual market has fallen from 17 to two. Moreover, we’ve learned that having coverage doesn’t mean getting care. In fact, emergency room visits increased under Obamacare.

Initial estimates indicate that we see coverage fall initially under AHCA as well, but the change would be because of choice not a lack of access. More specifically, the nonpartisan Congressional Budget Office reports that most of the reduction in coverage is related to people having the freedom to leave their plans. I believe you deserve this choice.

It took a year for President Obama to pass the Affordable Care Act. Why are Republicans moving so quickly?

The AHCA didn’t happen overnight. We’ve been working on this for years! Starting in 2010, Republicans began sharing the principles they’d like to see reflected in our health care system. Over the years, we’ve held dozens of hearings to help learn from Obamacare’s failures and develop better alternatives. In June 2016, we published a comprehensive look at our findings and proposals. Using this framework and taking direction from the newly elected Trump administration, House Republicans introduced the AHCA. Two House committees, Ways & Means and Energy & Commerce, then considered the bill in public sessions called “markups.” The bill ultimately passed the House in May after the adoption of two amendments. The legislative process now continues in the Senate.

I have a preexisting condition. What does the AHCA mean for me?

Let me begin by clearing up some misperceptions. Under the AHCA:

  • Insurance companies CANNOT deny you coverage because you have a pre-existing condition.
  • There are NO annual or lifetime limits.
  • As a general rule, your premiums CANNOT go up because of a pre-existing condition.

With this in mind, the AHCA does allow for states to come up with innovative programs to better cover those with pre-existing conditions. This is the area that is creating some confusion.

In many states, the individual marketplace is collapsing. In Iowa, for instance, 94 of 99 counties have zero insurers. In South Dakota, the options aren’t much better; we only have two.  To alleviate this problem, the AHCA allows states to request waivers in order to incentivize insurers to return and ultimately lower premiums. To get a waiver, a state must prove it has safety net protections in place for those with pre-existing conditions and the AHCA includes $138 billion in funding to help make these new programs successful.

Even if your state receives a waiver, an insurance company cannot increase your premiums because of a pre-existing condition unless ALL of the following occur:

  1. You are one of the 7% of Americans who purchase insurance on the individual or small group insurance markets (this would not apply to Medicare, Medicaid, IHS, or employer-sponsored plans), AND
  2. You live in a state that sets up its own protections for those with pre-existing conditions and receives a waiver because of it, AND
  3. You have a lapse in coverage for longer than 63 days.

If all three of these conditions are met, your state will pick up at least part of the additional premium with federal dollars.  Moreover, at the end of the year, the insurance company can no longer consider your pre-existing condition, so your premium will go back down.

I heard rape, sexual assault, and domestic violence could be considered pre-existing conditions. Is that true?

NO. And you don’t just have to take my word for it.  The Washington Post’s independent Fact Checker reported: “the notion that the AHCA classifies rape or sexual assault as a preexisting condition, or that survivors would be denied coverage, is false.” It rated the claim “Four Pinocchios,” saying it was based on “out-of-control rhetoric.”

How does AHCA support Medicaid recipients?

The Medicaid program is a critical lifeline for some of South Dakota’s most vulnerable patients, but the program today has three times as many people – and costs three times as much – as it did under President Clinton. By expanding Medicaid, Obamacare prioritized able-bodied adults above those the Medicaid program was originally designed to help.

To realign the program with its initial goals, AHCA freezes Medicaid expansion in states that chose to expand (South Dakota did not), while grandfathering in existing enrollees. This freeze policy would prevent disruption for current Medicaid beneficiaries, but also transition able individuals to purchasing private coverage in an improved commercial market with (1) the support of a refundable tax credit and (2) through innovative programs established in their state and funded by the AHCA’s robust Patient and State Stability Fund.

What does AHCA mean for women’s health?

This legislation doesn’t divert even a penny away from women’s health.  Instead, it affirms that taxpayers cannot be asked to subsidize abortions.  More specifically, it directs over $500 million in federal funding to community health centers, which is money that currently goes to Planned Parenthood. Not only do these health centers refrain from performing abortions, they also offer greater access and more comprehensive care to South Dakota women.  In fact, while there is only one Planned Parenthood clinic in the state, we have five community health centers that operate in more than 40 sites across the state, including areas that are designated as medically underserved, which Planned Parenthood does not.

Does AHCA impact health care for veterans?

AHCA won’t change the status quo for veteran health care. Currently, veterans can choose the VA or the individual market. That is not expected to change, which the federal regulating agency has confirmed. To put a point on this, however, I’ve also helped introduce legislation to give veterans the certainty of law that they can choose VA care or a plan in the individual marketplace. The decision ought to be theirs.

I get health insurance through my employer. Will I be subject to AHCA’s changes to Essential Health Benefits?

No. Some media outlets have wrongly reported that employer-sponsored insurance could be affected by the changes to Essential Health Benefits requirements. That’s false. AHCA’s Essential Health Benefits provisions only apply to individual and small group markets (or about 7% of the American population) and the Department of Health and Human Services has publicly assured us this is how they plan to implement the law as well.

Would AHCA apply to Rep. Noem’s health coverage?

YES! Congress shouldn’t get special treatment. I am currently on Obamacare and I voted specifically to make sure Congress would be subject to changes that AHCA would make.

  

If you're interested in learning more or reading through the legislative language, please click here.

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