The AHCA Could Still Devastate Your Insurance, Even if You Have an Employer Plan

May 4th 2017

Mike Rothschild

Most of the media focus on the health care debate has been on individual plans purchased by people who don't get employer coverage. But the Wall Street Journal uncovered a deeply-buried provision in the American Health Care Act (the Republican replacement bill for the Affordable Care Act) that has the potential to remove protections that curb out-of-pocket costs for "catastrophic illnesses," for people who have large employer-funded plans.

According to the Journal, the provision is part of one of the many amendments to the original bill, which failed to get a vote in March. It would allow states to "obtain waivers from certain Affordable Care Act insurance regulations," the Journal reports. "Insurers in states that obtain the waivers could be freed from a regulation mandating that they cover 10 particular types of health services, among them maternity care, prescription drugs, mental health treatment and hospitalization."

The ACA (Obamacare) currently prevents employer plans from putting annual limits on coverage, and it bars lifetime limits on these 10 essential benefits. But as the Journal writes, back in 2011, "the Obama administration issued guidance stating that employers aren’t bound by the benefits mandated by their state and can pick from another state’s list of required benefits."

That language was mostly rendered moot by other provisions of the ACA.

However, under the AHCA, large employers could choose to operate under the benefit requirements from any state — including those with waivers that exempt employers from lifetime coverage limits.

For example, hypothetically, if you worked for a company in California, which, let's say, didn't waive coverage of certain health services, your company could opt to use an insurance provider from another state that had lifetime limits on out-of-pocket costs.

The provisions would essentially be a backdoor strategy for companies looking to lower their costs, and could force the individual patient to pay the difference between their cost and what their insurance will cover, a number that could run into six figures for major illnesses.

This is just one of several provisions buried in the language of a bill that only became public just prior to the vote, and many House Republicans admit they won't have read when they vote on it.

The New York Times found that among the bill's most drastic cuts to Medicaid (which President Trump had promised not to touch) was a measure that would impose a "per-capita cap" on the services Medicaid will fund for special education. Schools would also no longer be considered Medicaid providers, leaving them ineligible for reimbursements.

There is also concern that among the pre-existing conditions that the AHCA will no longer cover are many specifically affecting women, including caesarian sections, exams after sexual assault, and post partum depression.

One physician summed the potential impact of the AHCA on women in a quote to Elle magazine: "I see the benefits of ACA every single day. I saw patients in my practice who had not been able to get health insurance for five, 10 years finally come in and get care because they could finally afford the premiums, or get maternity coverage."