As the 2016 election looms many irrelevant issues are monopolizing the news media and blogosphere. A direct result of this is important issues that truly impact our nation are rarely discussed. And when issues are discussed they are frequently in generalizations and rarely in specifics or with any details. From immigration to international affairs both Presidential candidates are providing broad sweeping solutions without precise details.
One vital issue that will effect every American that will be decided in the coming election is the fate of the Affordable Care Act. It is clear that if Hillary Clinton is elected the Affordable Care Act (ACA) will likely remain. She has proposed several changes to the law including creating the ability of individuals to buy Medicare before they turn 65. (This is commonly referred to as the “Public Option”.)
If Donald Trump wins the White House there is a strong likelihood that the ACA will be repealed. The resulting legislative vacuum would require the passage of legislation to govern healthcare delivery.
Since 2010 the Republican Majorities in the US House and Senate have attempted to repeal the Affordable Care Act on multiple occasions with the intention to replace it with an alternative healthcare law. In June 2016 Senator Richard Burr (R-NC), Senator Orrin Hatch (R-Utah) and Representative Fred Upton (R-Mich) released a comprehensive Republican proposal to replace the ACA. Their proposal, called the Patient Choice, Affordability, Responsibility and Empowerment Act (CARE), if passed and signed by the President, could replace the ACA.
Listed below are a summary of the changes that would be brought about with the implementation of the CARE Act.
|AFFORDABLE CARE ACT||CARE ACT|
|INIDIVIDUAL MARKET REFORMS|
|-Requires individuals, with certain exceptions, have health insurance
-Requires health insurers to offer coverage regardless of pre-existing conditions. Annual open enrollment period. Rates are limited to considering age, place of residence and smoking status
-Older adults can be charged no more than 3 times as much as younger adults (3 to 1 banding)
-Eliminates annual and lifetime limits within health insurance policies.
-Mandates preventative care is covered
-Mandates that health insurance covers the diagnosis and treatment of certain conditions and illnesses
-Allows families to keep children on insurance until they are 26 years of age.
-Limits out of pocket expenses for health insurance policy holders
|-Does not require individuals have health insurance
-Requires health insurers to offer to coverage to buyers at standard rates based on age and place of residence so long as they maintain continuous coverage for at least 18 months. If individuals lose coverage for any period they are no longer guaranteed insurance accessibility.
-One-time enrollment period for all without health insurance.
-Older adults can be charged no more than 5 times as much as younger adults (5 to 1 banding)
-After the onetime open enrollment period insurers may refuse to offer health insurance to individuals with pre-existing conditions or adjust rates based on prior health conditions if they have interrupted health insurance coverage
-Eliminates lifetime health insurance limits but allows annual limits
-Eliminates the requirement that preventative care is covered.
-Eliminates mandate of what insurance covers
-Eliminates out of pocket limits.
|-ACA offers tax credits paid directly to health insurers to individuals between 100 and 400% of the federal poverty level who do not have Medicaid, VA Care or employer based insurance.
-ACA offers tax credits to small businesses who offer health insurance to employees.
-To receive tax credits individuals are required to pay a percentage of their insurance premium based on income and insurance plan chosen (varies between 2% and 9.5%).
-The amount individuals receive is based on the cost of the insurance premium, income and family status.
-Individuals between 100% and 250% of federal poverty level also qualify for assistance to pay copays and share of cost.
|-CARE Act offers tax credits to small businesses and individuals who do not work for a large business or who do not have other access to health insurance.
-Fixed Tax credit varies with age, income and family status. See below*:
Age Individual Family
18-34 $1970 $4290
35-49 $3190 $8330
50-64 $4690 $11,110
-Those at 200% of FPL would qualify for 100% of tax credit.
-Tax credit would adjust between 200 and 300% of FPL (0% tax credit at 300% of FPL)
-Medicaid recipients could opt to receive tax credit in lieu of Medicaid
-Tax credits increase annually fixed to Consumer Price Index
|• Allows states to expand Medicaid to individuals making 138% of less of FPL.
• Share of cost between federal government and the states
• Federal government sets conditions for how Medicaid is provided and what services must be covered under Medicaid
|• Converts Medicaid to a capped allotment to the state based on pre-2014 spending in each state adjusted for inflation and demographic change
• Eliminates funding for Medicaid expansion to individuals making between 100-138% of FPL but allows these individuals to access tax credits
• Eliminates federal mandates for services and coverage of Medicaid and allows states more flexibility in what services would be covered under Medicaid.
|HIGH RISK POOLS|
|• Not necessary as insurers must accept all individuals desiring health insurance||• Would create funds for state run high risk insurance pools. These pools would move the most expensive individuals out of the individual market place thereby reducing premium for the remaining population. **|
|• Provides for funds for states to try “Demonstration Projects” to experiment with malpractice reform to see what works.||• Does not provide specific plan but refers to implementing caps on non-economic damages (pain and suffering), limiting attorney’s fees, dispute resolution committees and payment|
|TAX EXCLUSION FOR EMPLOYER INSURANCE|
|• Imposes a 40% excise tax on employer provided health insurance plans in excess of $10,200 for the individual or $27,500 for a family. (Not expected to take effect until 2020)||• Imposes a 40% excise tax on employer provided health insurance plans in excess of $12,000 for the individual or $30,000 for a family.|
ASPECTS OF THE AFFORDABLE CARE ACT NOT INCLUDED IN THE CARE ACT
•Penalties on hospitals for excessive readmission rates and hospital insurance tax on individuals with high income. (Congressional budget office estimates these changes will reduce deficit by $802 million between 2016 and 2025.)
•Funding for nursing and medical education.
•Funding for community health clinics and health centers.
*Average National Annual Health Insurance Premiums for lowest level Bronze Plan 2014 (Source: https://spe.hhs.gov/report/health-insurance-marketplace-premiums-2014-september-2013) and E-health Insurance.
Note: Health insurance premiums are very variable based on location. These are national averages only for comparison
25-34 year old Single adult: $2652 ($221/month) Family: $5112
35-44 year old Single adult: $3312 ($276/month) Family: $6834
45-54 year old Single adult: $4308 Family: $9804
55-64 year old Single adult: $6228 Family $12,688
**Analysis has found that high risk insurance pools are prohibitively expensive to administer, are prohibitively expensive for consumers to purchase and provide less than optimal coverage.
So as you consider your vote this coming November consider the real and significant impact that vote will have on the health of you and your family!