Even with National Public Radio in her ear and The New York Times online, Charlotte bartender Sara Kelly Jones woke up confused Friday and “terrified all over again” about her healthcare future.
Republicans in the U.S. House voted Thursday to repeal and replace the long-reviled Affordable Care Act after seven years of pledging to do it. The measure still has to be approved by the Senate, which could demand significant changes, but President Donald Trump promises insurance premiums will drop for Americans.
Jones, 47, who has health insurance under Obamacare, suffers constant pain from severe arthritis and works on her feet. She needs corrective surgery and feels growing pressure to decide whether to schedule it. This time next year, she says, her coverage could be gone.
Under the House bill, states would be able to get federal waivers letting insurers charge higher premiums to people with pre-existing illnesses who let their coverage lapse. States could use federal money to fund “high-risk pools” for patients unable to afford conventional coverage.
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“I don’t know how that would play out for me,” Jones said. The House bill was lacking in key details, she said, and seemed like a ploy to get a victory for the Trump administration. Insurance companies, she suspects, will make out better than she will.
“I’m in the wind,” she said, “and I don’t know what’s going to happen.”
North Carolina has 1.6 million adults with pre-existing health conditions, including 86,000 who buy health insurance individually through the Affordable Care Act, The (Raleigh) News & Observer reported.
U.S. Rep. Robert Pittenger, a Charlotte Republican who voted for repeal, this week defended his support of a provision that would let some states charge more for coverage of pre-existing conditions. “People can go to the state that they want to live in,” he told reporters.
The fact-checking website PolitiFact North Carolina called the claim that patients with those conditions would still be protected “mostly false.”
The House bill proposes setting aside $8 billion to help states cover people who may be subject to higher insurance rates because they’ve had a lapse in coverage, The Associated Press reported. That’s on top of about $100 billion over a decade for states to help people afford coverage and stabilize insurance markets.
The problem, experts told the AP, is that the money is unlikely to guarantee an affordable alternative for those who now get coverage under Obamacare provisions. An analysis by the health care consulting firm Avalere found that the money would only be enough to fund high-risk pools in a few small states. High-risk pools could fill up fast with patients who have a lapse in coverage.
“Many people with pre-existing conditions will have a hard time maintaining coverage because it just won’t be affordable,” said Larry Levitt, a health insurance expert with the Kaiser Family Foundation, told the AP.
North Carolina healthcare experts say limits to pre-existing conditions are only part of sweeping changes under the House bill.
“It’s going to increase premiums for everyone,” said Doug Sea, who practices health law at Legal Services of Southern Piedmont.
Sea predicts more uninsured people will seek care they can’t pay for, forcing hospitals to shift costs to those with insurance. Older people would see premiums go up because the legislation removes the age ratings that stabilized costs under Obamacare, he said. And because North Carolina legislators didn’t expand Medicaid care for low-income patients under Obamacare, the state would lose more federal money as the repeal bill shrinks federal reimbursements.
“It doesn’t matter how sick the population is, or that people are getting older, the states would have no choice but to raise taxes or cut coverage,” Sea said. More rural hospitals, already under financial strain in economically stagnant areas, would likely close, he said.
Brendan Riley, a health policy analyst with the North Carolina Justice Center, said healthcare would be harder to get, less affordable and further out of reach for most N.C. residents.
A repeal of the individual mandate for insurance coverage, Riley said, would leave an older and sicker pool of covered people who would pay higher premiums. Waiving requirements for core coverage requirements, such as for maternity care, would leave more sick patients and more medical debt, Riley said.
The Congressional Budget Office estimated in March that the Obamacare repeal bill being debated at that time would leave 24 million Americans uninsured over 10 years.
“I could not foresee a situation in which that situation would be improved” by the new bill, Riley said.