Trumpcare and the repeal of Obamacare — what’s going to change and what’s not?
President-elect Trump’s agenda calls for repeal of the Affordable Care Act. This may be possible with a Republican Congress – but I don’t think complete repeal is going to happen – or even that it should happen.
Before you repeal something, you should know what it is, so first let’s ask: What exactly IS Obamacare?
- • Insurance companies can’t turn you down if you are sick
- • All policies must cover the same essential benefits. (Remember the Empire Blue Cross hospital-only plan? Cost less than $500 for a family to get full hospital and ER coverage. Pretty good deal! It’s gone now – legislated out of existence.)
- • Premium subsidies for people that can’t afford the premiums
- • No pre-existing conditions
- • Penalties if you don’t buy health insurance
- • And no you can’t (necessarily) keep your doctor, so stop asking
In April 1993, community rating for small groups became law in New York. Here are the bullet points:
• Community rating means everyone pays the same price regardless of age, gender, or health. Whether 25 or 65 – sick or healthy – same price
• No more health questions- ever. You could not be turned down or charged more if you were sick. (Not so with other states- if you were sick, you could be turned down completely for coverage.)
• Pre-existing conditions were paid for immediately if you were already covered and switched plans. If you had no previous coverage, you still couldn’t be turned down, but preexisting conditions wouldn’t be paid for immediately. The intent was that if a person remained (more or less) continuously insured, that person would only have to satisfy a pre-existing waiting period once in his/her lifetime. Seems reasonable to me.
With a couple of tweaks – and ignoring the subsidies and penalties – this IS Obamacare (or close).
Oh yes — what happened in 1993? Many health insurance companies fled the state to wait and see what happened. BUT — and this is big — it all worked out just fine. Things settled down, new companies came into the market – the good old days. New York got there 20 years ahead of the rest of the country! (I never understood why our politicos didn’t beat the drum about this.)
So, what’s likely to change, and what’s not?
- • Expect a major overhaul of the Federal Healthcare Exchanges
- • Medical questions and pre-existing conditions? This won’t change
- • Individual penalties for not buying insurance- I would hope to see this go away. Don’t penalize people, just bring the prices down
- • Expect to see more transparency from healthcare providers. Why don’t I know what my broken leg is going to cost until I get the bill? Again, just asking.
- • It will be an uphill battle to allow consumers to buy safe prescription drugs from overseas or Canada- (And why are Rx drugs so much cheaper in Canada? Just asking.)
- • Allow insurance companies to sell insurance across state lines – to encourage competition and bring prices down. This sounds good, but I don’t see how that will bring prices down. Companies can already do this if they comply with state requirements.
- • Deductible premiums- expect that soon.
A final question: Why did health insurance reform work in New York and fail in the rest of the country? What’s different? That’s a question that should be answered. Use New York as an example, Mr. Trump. After all, you are a New Yorker!
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