managing chronic disease

With the presidential inauguration only a few days away and the Republican-controlled Congress on a fast track to repeal the Affordable Care Act, it’s essential for all of us who live with chronic diseases to understand what’s happening to health insurance coverage. Much is still in flux. I have been staying up far too late recently, reading the most reliable sources I can find to follow the pace and direction of “repeal and replace” of Obamacare.

I do not intend to turn this blog into a political forum on the issue. However, I will confess that I am deeply alarmed by what’s happening in Washington and what I perceive as the significant risks of repealing a flawed but beneficial law with no clear plan to replace it. The drafting of the ACA involved many participants in the health care system. Its replacement deserves similar, deep discussion and debate, and enough time to consider all the implications—especially for the millions of Americans who may now lose health insurance without the means to purchase needed coverage, if insurance subsidies provided under the ACA are eliminated.

The procedural rules that Republicans are using to push through reform are complex. The process of ACA repeal began last week with a special budget process called reconciliation, which requires only a simple 51-49 majority in the Senate and precludes filibuster by opponents. In accordance, both Houses passed a blueprint for repealing Obamacare. There is a long way yet to go. Here is a January 13, 2017 article by Margot Sanger-Katz from the New York Times that explains all the steps: Obamacare Repeal is Moving Forward. When Will Changes Affect Consumers?  As she notes, it’s highly unlikely that those currently covered by the ACA will feel the effects this year of a potential repeal.

I have been very fortunate to have excellent health insurance through my husband’s employer. Since I work for myself, buying private insurance, even in Massachusetts, which created the prototype for Obamacare, is expensive. But I know I can get it if I need to, even though I’ve had scleroderma for more than three decades.

At stake for so many out there with serious health issues is the pre-existing condition protection provided by the ACA. So far, the president-elect has expressed an interest in preserving this aspect of the law. But, it’s complicated. Here is an excerpt from another piece by Sanger-Katz, explaining what’s at stake. You can read the full article here: The Biggest Changes Obamacare Made, and Those That May Disappear

One of the law’s signature features prevents insurance companies from denying coverage or charging a higher price to someone with a pre-existing health problem. The law included a host of other protections for all health plans: a ban on setting a lifetime limit on how much an insurer has to pay to cover someone; a requirement that insurers offer a minimum package of benefits; a guarantee that preventive health services be covered without a co-payment; a cap on insurance company profits; and limits on how much more insurers can charge older people than younger people. The law also required insurance plans to allow adult children to stay on their parents’ policies until age 26.

What would happen? These rules can’t be changed using the special budget process, so they would stay in place for now. But eliminating some of the other provisions, like the subsidies, and leaving the insurance rules could create turmoil in the insurance markets, since sick customers would have a much stronger incentive to stay covered when premiums rise.

What might replace it? Mr. Trump has said that he’d like to keep the law’s policies on pre-existing conditions and family coverage for young adults, but Senate Republicans recently voted against nonbinding resolutions to preserve those measures, suggesting they may be less committed. Some of the other provisions would probably be on the table if there were new legislation. Republicans in Congress would probably eliminate rules that require a minimum package of benefits for all insurance plans and allow states to determine what insurers would have to include. Mr. Trump has said he’d like to encourage the sale of insurance across state lines, a policy likely to make coverage more skimpy but less expensive for many customers. Republicans would also like to expand tax incentives for people to save money for health expenses.

Many of the Republican proposals would also establish so-called high-risk pools, which would provide subsidized insurance options for people with chronic health problems who wouldn’t be able to buy insurance without rules forcing insurers to sell them coverage.

The debate is far from over. We each have an opportunity to express our views to our congressional representatives. Whatever your opinion on this subject, please read beyond tweets and headlines, be informed and willing to listen to other points of view, and make your voice heard.

Evelyn Herwitz blogs weekly about living fully with chronic disease, the inside of baseballs, turtles and frogs, J.S. Bach, the meaning of life and whatever else she happens to be thinking about at livingwithscleroderma.com.

Image Credit: Pablo Garcia Saldaña