Demise of Trumpcare on Steroids (AHCA II)

There is a great article by MARGOT SANGER-KATZ in the NY Times today, which makes this complicated topic quite simple. This is about the amended AHCA (AHCA II) as dratted by Tom MacArthur, a New Jersey congressman. This legislation was meant to appease the hardline Freedom Caucus but of course it upset the moderates among the Republicans and was withdrawn last night to our relief. But I think we should still try to understand it!

AHCA II would set up a waiver program to allow states to eliminate three major insurance regulations established by Obamacare.

1) Essential Health Benefits

A basic set of benefits, including hospital care, prescription drugs and maternity care, that must be included in all health insurance.

2) Pre-existing conditions

A pillar of Obamacare that prevents health insurers from charging higher prices to customers with pre-existing conditions. Eliminating this requirement would be very unpopular and Donald Trump promised he would not do that during the campaign.

3) Age Rating

Rules about how much more insurance companies can charge older customers than younger ones. The Republican bill would shift the default from 3:1 to 5:1   which is bad enough, but now states could shift this ratio even further (say 10:1) so that older people pay 10x more than younger people for their health insurance.

AARP says that 40 percent of those between the ages of 50 and 64, or about 25 million people, have the kinds of pre-existing medical conditions that would put them at risk of losing affordable health insurance under this bill. The usually very conservative American Medical Association is even more pessimistic, predicting that the MacArthur amendment “could effectively make coverage completely unaffordable to people with pre-existing conditions.”

Clearly, lawmakers need to listen carefully to all the interested parties: hospitals, providers, insurance companies and patient advocates, before they come up with AHCA III!


About D. Posnett MD

Emeritus Prof. of Medicine, Weill Cornell Medical College
This entry was posted in American Health Care Act, Health Care, Medicaid, Uncategorized. Bookmark the permalink.

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