#WorstTBTEver: The “Future” of Health Care Looks a Whole Lot Like the Past

Despite outcry from their constituents throughout the country, some members of Congress are still pushing ahead with their plan to repeal the Affordable Care Act (ACA), also known as Obamacare. After seven years of trying to repeal the law, these Members and the Administration are just now realizing that health care is complex and that people want a guarantee they won’t lose their health coverage.

House Republican leaders have finally released some vague details about their proposed replacement and last week, a draft of a replacement bill was leaked, providing the fullest picture of what the future of health care may look like under ACA repeal and replace.
Unfortunately, the future under this plan looks a whole lot like the past. The House Republicans’ “plan” makes clear that ACA repeal and replace will return us back to a time when women, lower-income working families, or people with pre-existing conditions were often unable to find insurance coverage due to discriminatory practices and high prices.
In this #WorstTBTEver blog, we will break down four things you need to know about the “so-called” House Republican replacement plan.

It eliminates Medicaid expansion and dramatically cuts traditional Medicaid. We’ve already laid out the importance of Medicaid and Medicaid expansion for lower-income women and families. Nevertheless, the House Republican plan would end the Medicaid expansion, taking away health insurance coverage from these individuals and families and throwing them back to a time before the ACA when they did not qualify for Medicaid and also could not afford private coverage. Moreover, the House Republican plan cuts traditional Medicaid funding, changing it to a “per capita caps” system—which will shift costs to already burdened state budgets, forcing states to either cover fewer people or provide enrollees with lower-quality coverage.

It ends required coverage of Essential Health Benefits like maternity care and preventive services. The House Republican plan will eliminate the Essential Health Benefits requirement that tells plans they have to cover a core set of important services, like maternity and newborn care, preventive services, and prescription drugs. It will leave it to the states to determine what plans must cover. This will force us back to a time when a patchwork of protections meant that the quality of your coverage depended upon your zip code and women couldn’t get coverage for needed services. For example, prior to the ACA, only 9 states required insurers on the individual market to cover maternity care.

It penalizes people with pre-existing conditions. As we’ve previously described, before the ACA, insurance companies treated being a woman like a pre-existing condition. The ACA ended this practice, prohibiting insurance companies from denying coverage to individuals based upon pre-existing conditions. Congressional members set on repealing the ACA and the Administration often claim that they will maintain this pre-existing conditions provision, but their replacement plans consistently include language that undermines that claim. Under the House Republican plan, if an individual with a pre-existing condition has a gap in coverage for a specified period of time, they will be forced to pay a higher premium in order to receive coverage. This penalty could make coverage completely unaffordable, in effect denying the individual coverage. There are numerous scenarios under which an individual could lose continuous coverage, like losing a job, going back to school, or choosing to pay for groceries one month instead of paying a premium. If that were to happen under this plan, they would lose the pre-existing condition protection and once again face insurance coverage denials.

It gives individuals who don’t need help paying for health insurance a windfall without helping those who need it. Prior the ACA, obtaining affordable insurance coverage in the individual market was nearly impossible for millions of people. The ACA did many things to make insurance in the individual market more affordable such as helping people pay for a portion of their monthly premium with subsidies calculated based on their household need. This provision has helped nearly 9.4 million people get health insurance in the individual market. Under the House Republican plan, these tax credits will not be calculated based on income, but rather on age. This means a younger family who needs help paying for health insurance will get less than an older family who doesn’t need help. Moreover, the proposed tax credits will be less generous than the subsidies under the ACA, and are unlikely to cover the costs of a plan that covers routine health care. This plan takes these families back to a time when health insurance was unaffordable, and inexplicably gives a windfall to people who can afford coverage.

As an added “bonus,” the plan denies federal reimbursement to Planned Parenthood and punishes individuals who purchase plans that cover abortion. The House Republican plan denies federal funding to Planned Parenthood, the only source of low-cost preventive and other health care for millions of women, men, and children.

It also punishes women who purchase insurance plans that cover abortion. The ACA currently treats coverage of abortion differently—and worse—than other health benefits. It allows states to prohibit plans from covering abortion, which 25 states have already done, meaning that women in those states cannot purchase a comprehensive plan that includes abortion. The leaked House Republican plan would make it even worse for women who seek abortion coverage. If a woman is in a state that allows insurance coverage of abortion, she would face a financial penalty if she chooses a plan that covers it. This is unfair and would especially harm those who need financial help in order to purchase health insurance coverage.
Repeal and replace of the ACA will throw us back to a time when health insurance simply didn’t work, especially for women, lower-income families, and the sick. That’s why Congress should abandon these so-called “replacement” plans that reuse failed ideas and listen to this constituent in Iowa: “Don’t repeal Obamacare — improve it.”
Don’t miss our other #WorstTBTEver blogs:
Post 1: When Millions of Women Fell into the Coverage Gap
Post 2: When Being a Woman Was a Pre-Existing Condition
Post 3: When Health Insurance Was Out of Reach
Post 4: When Your Zip Code Determined Whether You Could Get Affordable, Comprehensive* Health Insurance
Post 5: When There Was an Unmet Need for Birth Control Coverage
Post 6: When There Were “Winners” and “Losers” in Health Care
Post 7: When Americans Living with HIV Couldn’t Get Health Insurance Coverage