American Health Care Act

Essential Health Benefits Under the AHCA (ACA Replacement)

What are Essential Health Benefits (EHB)?

The Affordable Care Act requires non-grandfathered health plans in the individual and small group markets to cover essential health benefits (EHB), which include items and services in the following ten benefit categories: (1) ambulatory patient services; (2) emergency services; (3) hospitalization; (4) maternity and newborn care; (5) mental health and substance use disorder services including behavioral health treatment; (6) prescription drugs; (7) rehabilitative and habilitative services and devices; (8) laboratory services; (9) preventive and wellness services and chronic disease management; and (10) pediatric services, including oral and vision care.
— The Center for Consumer Information & Insurance Oversight - https://www.cms.gov/cciio/resources/data-resources/ehb.html

 

Prior to the ACA, health insurance was not required to cover the benefits above.  Health insurance could exclude prescriptions, pediatric services,  hospitalization, maternity and prenatal care and mental health services.  The EHBs are also tied to the limits on consumer spending for these services.  Currently, out of pocket costs for an individual cannot be more than $7,150 and for families the cost cannot be more than $14,300. Under the AHCA, states could apply for waivers and the costs for EHBs would no longer be capped.   

 

Let's compare the benefits in the ACA to the AHCA. 

While it is true that your monthly premium might be less under the AHCA, if you live in a state that gets a waiver, all the EHB may not be included in your health plan. If your health situation changes, you could pay much more for services that are currently included in all health plans.  

An Example

For example, a state could remove coverage for maternity or newborn care from the essential health benefits. Prior to the Affordable Care Act, most health plans did not cover maternity care, and pregnant women would have to pay the full cost of prenatal care, labor and delivery. That could happen again. 

In fact, women's healthcare is particularly targeted. Under the AHCA, Planned Parenthood would not be able to get Medicaid reimbursals for pap smears, birth control, or cancer screenings. Since Planned Parenthood is the largest reproductive health care provider in the country, it is likely that removing them as a provider--with or without removing the essential health benefit of contraception--will mean many more unintended pregnancies. For middle-income women, over the income cap for Medicaid, the birth and expenses would not be capped so you could pay $15,000 or more for a birth with complications.

The AHCA--the "replacement" for the ACA--goes next to the U.S. Senate. If you support comprehensive and affordable health care, let your senator know that you oppose the repeal of the ACA. 

Have questions?  Ask them in the comments section and we will do our best to answer. Call 734-544-3030 or Walk-in to the Washtenaw Health Plan office Monday - Friday from 9am - 4pm.   

-Meredith Buhalis and Ruth Kraut

Print Friendly and PDF

Subscribe to our blog here!

The Proposed American Health Care Act: What Would Replacing the Affordable Care Act Mean?

The American Health Care Act (AHCA) was introduced to Congress by Republican leadership on March 6, 2017.  The AHCA is a proposal that would replace the Patient Protection and Affordable Care Act (ACA, sometimes called Obamacare). The changes would reduce coverage options and make coverage unaffordable for many of the 20 million people who recently got covered under the Affordable Care Act. 

The Washtenaw County Board of Commissioners does not support any weakening of the ACA. Read the Resolution Opposing the Repeal of the Affordable Care Act and Supporting Additional Efforts to Strengthen Healthcare Access for All for in Washtenaw County

Groups that would suffer under the proposed changes 

Older Americans could be charged up to 5 times more than someone younger.  The ACA currently allows a 3 to 1 ratio. So if currently, the premium for a 20-year old is $200/month, the premium for a 64-year old could not be more than $600/month. Under the proposed law, a 64-year old could pay $1000/month.

States would need to pay much, much more for Medicaid. Currently, 31 states have expanded Medicaid.  The AHCA ends federal funding for new Medicaid enrollees post -2019. This means that states would foot the entire bill for new Medicaid recipients, which would be unaffordable to states and would force the Medicaid expansion to be severely curtailed or ended.  

Lower-income Americans would bear the brunt of the burden. People currently receiving ACA coverage, particularly those with low incomes, receive tax credits and cost sharing (lower deductibles and lower maximum out-of-pocket expenses) based on their income.  There would be no cost-sharing, which is a part of the ACA that benefits individuals under 250% of the poverty level (suggest an amount?). The AHCA replaces income-based tax credits and cost sharing with a universal tax credit. As can be seen in the map below, this benefits younger individuals and people with higher incomes.

Essential benefits would no longer be "essential" for people on Medicaid. Currently, there are ten essential health benefits, including treatment for substance use disorders, mental health, contraception. Under the proposed law, they would not be essential for people on Medicaid.

Contraception for low-income women is threatened. In addition to not requiring the same essential health benefits for people on Medicaid (thus making contraception "optional" for coverage), the proposed law bars Planned Parenthood from receiving reimbursements for services through Medicaid,  even though federal law already bans the use of federal funds for abortions.  Planned Parenthood is a major provider of contraception (and cancer screenings and prenatal care) for women across the country, particularly low-income women, whether on Medicaid or uninsured. 

Under the ACA, geography plays a role in determining tax credits and premiums. Under the proposed legislation, geography is not relevant. Thus, in high-cost states like Alaska, more people will be adversely affected.

Read more Seven Groups That Could Complicate GOP Plans To Repeal Obamacare By Perry Bacon, Jr.  March 7, 2017.

Who Wins and Who Loses Under Republicans’ Health Care Plan

The biggest losers under the change would be older Americans with low incomes who live in high-cost areas. Those are the people who benefited most from Obamacare.”
— Quealy and Sanger-Katz, New York Times, March 8, 2017

The New York Times map below shows how tax credits change for different age groups.   As your income goes up, you benefit across the board, but in general, older Americans will pay much much more.

New York Times By KEVIN QUEALY and MARGOT SANGER-KATZ MARCH 8, 2017

New York Times By KEVIN QUEALY and MARGOT SANGER-KATZ MARCH 8, 2017

Read more: Who Wins and Who Loses Under Republicans’ Health Care Plan By Kevin Quealy and Margot Sanger-Katz, March 8, 2017.

 

Use the tools below to compare proposed plans and premiums based on age, income, community, gender and more.

Compare Proposals to Replace The Affordable Care Act 

The Kaiser Family Foundation has a comparison tool that allows comparison of the ACA to the AHCA and other replacement proposals.  Comparisons can be made across various areas: Women's Health, Individual Mandate, Medicaid, Medicare, Cost-Sharing and more.  

Tax Credits under the Affordable Care Act vs. the American Health Care Act: An Interactive Map

This map allows you to compare premium assistance across age, income, and location for the ACA and the AHCA in 2020.  The AHCA does not adjust premium assistance based on income or geographic location.  Under the AHCA, a 40-year-old who makes $20,000 receives the same $3000 premium assistance as a 40-year-old making $75,000.  Depending on where you live, this could pay your whole insurance premium or only a portion of it. 

Click here to compare your costs now with what they would be under the AHCA. 

 

How Many People Are Affected by Obamacare
Premium Increases? (Hint, It’s Fewer Than You Think)

Why the urgency to replace the Affordable Care Act? Republicans claim that premium increases are driving this choice. But how many people are actually affected by premium increases?

This interactive infographic explains that only 3% of people are affected by rising premiums.  

Read more How Many People Are Affected by Obamacare Premium Increases? (Hint,
It’s Fewer Than You Think)
 By Troy Griggs, Karen Yourish, and Margot Sanger-Katz. March 9, 2017.

 

Print Friendly and PDF

Subscribe to our blog here!