Countable Q&A: The GOP Healthcare Bill

There has been a lot of confusion surrounding the Republicans’ bill to repeal and replace Obamacare, so in an effort to bring some clarity to the debate we’ve answered some of your questions about the American Health Care Act (AHCA) below.

I am hearing that pre-existing conditions are back and that if you lose your insurance and don't re-enroll there is a penalty when you do sign up. Is this true? Please explain. — Jean L.

The Affordable Care Act’s (ACA or Obamacare) ban on denying health insurance coverage because of pre-existing conditions remains in effect under the AHCA. What the AHCA does is let states apply for a 10-year waiver from parts of Obamacare, like the essential health benefits mandate that requires health insurance plans to cover things like maternity care and mental health treatment. States that get a waiver would then be able to create their own essential health benefits standard, but health insurers would still be required to offer coverage to people with pre-existing conditions. Individuals with pre-existing conditions could only be charged higher premiums if they fail to maintain continuous health insurance coverage.

Where in the AHCA bill does it mention pre-existing conditions? I've seen articles saying they won't be covered, but having trouble deciphering where it says that in the bill. — Deb T.

Section 137(b) of the AHCA addresses pre-existing conditions, saying "Nothing in this Act shall be construed as permitting health insurance issuers to limit access to health coverage for individuals with preexisting conditions." It can be found at the bottom of page 91 of this PDF of the bill text.

As it is now written, would the AHCA affect Medicare? — Kathleen P.

The only changes the AHCA would make to Medicare both involve the tax code, no other reforms are included. An additional Medicare payroll tax of 0.9 percent imposed on taxpayers earning more than $125,000 as individuals or $250,000 for couples (in addition to the standard 2.9 percent payroll tax) would be repealed starting in 2023, and a tax deduction for expenses incurred under Medicare Part D would remain in place.

How can / will the AHCA affect those with insurance through their employers? — Allison

While the AHCA repeals Obamacare’s employer mandate — which requires businesses with more than 50 employees to offer health insurance to those working 30 hours or more per week or pay a tax penalty — it isn’t expected to cause most employers that currently offer plans to stop per the Kaiser Family Foundation. To the extent that states get and use waivers to change their definition of essential health benefits, that could impact the insurance plans employees get through their work and what is covered by the plan.

Did or did not the AHCA bill passed by the House include a clause to exempt members of Congress and their staff from pre-existing conditions etc.? I know originally it did include an exemption, but days prior to the vote an amendment was introduced by an Arizona rep. that disallowed this exemption and was passed. Which was one of the stepping stones to get it pushed thru. Is this not correct — Evelyn S.

The AHCA does contain a provision that exempts members of Congress and their staff from state waivers of Obamacare requirements like the essential health benefits mandate, but Congress is already moving to end that exemption. Rep. Martha McSally (R-AZ) introduced a separate bill to end that exemption, which the House passed 425-0 the same day it passed the AHCA. McSally’s legislation couldn’t be introduced as an amendment to the AHCA itself because of the Senate’s Byrd rule, which prohibits the upper chamber from considering an "extraneous matter" in a reconciliation bill. Had it been tacked on as an amendment to the AHCA by the House, senators could’ve raised a point of order against it, which could have led to the bill needing 60 votes rather than a simple majority to pass the Senate.

Does the AHCA do anything to cut actual health care costs? Does it reduce unnecessary requirements that increase the cost of health care? Does it reduce frivolous lawsuits that drive up malpractice insurance and cause doctors to order unnecessary procedures so they do not get sued? Does it recommend processes such as a national medical database to improve efficiencies? My point being if we are not doing anything to reduce costs and improve efficiencies then all this other stuff is just moving costs around. Thank you. — Joe W.

Why don't they just enable the insurance companies to sale across state lines? — Keely

The questions raised by Joe and Keely are also related to the Byrd rule, in that it restricts what legislative items Republicans can include in the AHCA itself. GOP lawmakers have spoken of a three-pronged approach to repealing and replacing Obamacare that includes regulatory action, passing the AHCA through the reconciliation process, and additional legislation.

The House has already started bringing up those additional "phase three" bills for a vote, passing legislation to let small businesses form associations for buying health insurance, ending the health insurance industry’s exemption from antitrust law, and clarifying that stop-loss insurance isn’t health insurance. Expect more bills of that nature to get a vote in the weeks and months to come.

Will the ACA remain in effect in its entirety until the final AHCA is passed? Will everyone who is paying premiums under the ACA automatically transfer into an AHCA program? Will the Senate version be scrutinized by a financial review agency prior to a vote? — Janet S.

A broad repeal of Obamacare will only occur with the passage of the AHCA, and while Congress could theoretically undo individual parts of it in the meantime, they’ve been focused on the AHCA. The process for enrolling in a health insurance plan would be essentially unchanged, so people would need to sign up for insurance during an open enrollment period. It’s too early to tell if the Senate’s potential rewrite of the AHCA will be scored by the Congressional Budget Office prior to a vote, but it’s worth noting that the Senate’s action won’t be the last, as the AHCA will likely head to conference committee to resolve differences between the House and Senate versions. The conference report, as the final product is called, will almost certainly be scored prior to a vote.

Up until what age will children be covered under a parent’s plan under the AHCA vs current ACA? — Susan B.

The AHCA doesn’t change Obamacare’s requirement that children be allowed to remain on a parent’s health insurance plan until they turn 26 years old.

Don't see your question answered here? Well don't worry, we'll be responding to more of your questions in an upcoming post so send them our way!

— Eric Revell

(Photo Credit: Office of the Speaker / Public Domain)