The new Republican majority in the House of Representatives just voted to repeal the Affordable Care Act. Everyone is arguing about what this means -- is it purely symbolic, or the first step on a longer road? I strongly believe it's the latter, and that today's vote means a great deal. Everyone, especially the progressive political community, should view this as the opening in a battle of messages that won't end soon.
The Price of Repealing the Affordable Care Act
Republicans say regulating the insurance industry is hurting the economy. The fact is that insurance companies need to treat everyone fairly. Repealing the Affordable Care Act would strip Americans of new freedoms and take us back to the days when big insurance companies had the power to dictate the cost and quality of care to the American people.
What freedoms? Let's take a quick look at the Patient's Bill of Rights, which includes new protections against aggressive insurance companies. These are the protections that have already kicked in, and that Republicans voted today to eliminate:
- No Pre-Existing Condition Exclusions for Children Under Age 19. New regulations will prohibit insurance plans from denying coverage to children based on a pre-existing condition. This ban includes both benefit limitations (e.g., an insurer or employer health plan refusing to pay for chemotherapy for a child with cancer because the child had the cancer before getting insurance) and outright coverage denials (e.g., when the insurer refuses to offer a policy to the family for the child because of the child's pre-existing medical condition). These protections will apply to all types of insurance except for individual policies that are "grandfathered," and will be extended to Americans of all ages starting in 2014.
- No Arbitrary Rescissions of Insurance Coverage. Under the regulations, insurers and plans will be prohibited from rescinding coverage - for individuals or groups of people - except in cases involving fraud or an intentional misrepresentation of material facts. Insurers and plans seeking to rescind coverage must provide at least 30 days advance notice to give people time to appeal. There are no exceptions to this policy.
- No Lifetime Limits on Coverage. One rule already in place from the Affordable Care Act prohibits the use of lifetime limits in all health plans and insurance policies issued or renewed on or after September 23, 2010.
- Restricted Annual Dollar Limits on Coverage. The rules will phase out the use of annual dollar limits over the next three years until 2014 when the Affordable Care Act bans them for most plans. Plans issued or renewed beginning September 23, 2010, will be allowed to set annual limits no lower than $750,000. This minimum limit will be raised to $1.25 million beginning September 23, 2011, and to $2 million beginning on September 23, 2012. In 2014, most plans will not have limits.
- Removing Insurance Company Barriers to Emergency Department Services. Health plans and insurers will not be able to charge higher cost-sharing (copayments or coinsurance) for emergency services that are obtained out of a plan's network. The rules also set requirements on how health plans should reimburse out-of-network providers.
Bottom line: The Republican repeal scheme denies you access to health care and puts your family-doctor relationship at risk. The unfortunate truth is that they're looking out for corporations and insurance companies ahead of your interests. I and other progressive advocates are working to protect and empower you to control your own health care. There probably isn't a middle ground.
Pre-Existing Conditions: A Big Deal
Despite Rep. Steve King calling denial of health care for pre-existing conditions "a minor thing," the Affordable Care Act makes it illegal starting in 2014 to deny anyone health insurance because of a pre-existing condition and has already outlawed denial on that basis for anyone under the age of 19. Even if your child was born with a heart defect, asthma or any other health condition, he or she can no longer be denied health insurance thanks to the Affordable Care Act.
This already matters to a lot of people, and will matter to a lot more as time goes on. As a recent government analysis shows, as many as one in two Americans over the age of 65 has at least one pre-existing condition that could lead to denial of health insurance. If the law is repealed, you, you parents or your grandparents could lose health coverage.
Hitting States Hard
This will affect both individuals and communities, and my home district in Southern Arizona is not the only one that would be hard hit by a full repeal. A quick overview shows that repeal will result in:
- Allowing insurance companies to deny coverage to 134,000 to 367,000 individuals, including 14,000 to 63,000 children, with pre-existing conditions.
- Eliminating health care tax credits for up to 13,000 small businesses and 211,000 families.
- Increasing prescription drug costs for 7,100 seniors who hit the Part D drug "donut hole" and denying new preventive care benefits to 88,000 seniors.
- Increasing the costs of early retiree coverage for up to 11,900 early retirees.
- Eliminating new health care coverage options for 4,400 uninsured young adults.
- Increasing the number of people without health insurance by 129,000 individuals.
- Increasing the costs to hospitals of providing uncompensated care by $36 million annually.
That's just in District Seven. Think of these numbers applied to your own community, and the Republican message starts to sound a little shakier.
Keeping the Indian Health Care Improvement Act
In addition to these crucial improvements, the Affordable Care Act reauthorized the Indian Health Care Improvement Act, which provides many needed tools and services to Native American communities nationwide. If Republicans repeal the entire law, the Indian Health Care Improvement Act goes with it. I don't believe that's in anyone's best interest.
I recently spoke to the House Rules Committee in favor of retaining the Improvement Act even if the rest of the law is undone. (Click here to watch my speech.) Unfortunately, Republicans decided not to have a vote on my proposed amendment. If their plans go forward, the Indian Health Care Improvement Act will disappear.
An Easy-to-Understand Guide to The Republican NoCare Agenda
Their agenda for America is:
- NoCare if you lose your job.
- NoCare if you or your child has a pre-existing condition.
- NoCare if you're a senior in the Medicare "donut hole."
- NoCare if you're under 26 on your parents' plan.
- NoCare if you get sick and your insurer drops your coverage.
- NoCare if your insurer hikes your premiums higher than you can afford.
What You Can Do: Call Congress (Believe Me, It Matters)
No matter where you live, call your House and Senate offices and make your voice heard. Tell them how you feel about taking away the new Patient's Bill of Rights. Tell them what it would mean to you to go back to the old health-care system, where insurance companies could drop anyone at any time for practically any reason. Even if you think your representative won't listen, your comments will make a difference. We can build a critical mass anywhere and everywhere if we make a point of speaking up. Otherwise, everyone will continue to tell us -- wrongly -- that repeal is popular.