Tag: essential benefits

The topic of health care is not only in some ways oppressive on our minds but also overwhelming these days. Months ago, the House wrote the American Health Care Act (AHCA) in an effort to repeal and replace the Affordable Care Act (ACA), and they passed it on to the Senate. Then, the Senate must have found fault with the AHCA because they wrote their own version of the bill called the Better Care Reconciliation Act (BCRA). If the Senate passes their bill, it will have to go to the House for their approval. We have seen months (years!) of coverage on the subject of health care, and it’s downright confusing at this point.

Let’s try to clarify some of the confusion by pulling a few articles together to show what will change with the Senate health care bill, the BCRA. (The AHCA doesn’t matter if the House approves the BCRA.) This research will show that nearly everyone who isn’t extremely wealthy will be affected negatively by the bill as it stands proposed today. If you care about, or are affected by, any of the following categories, you can expect changes to come to you and your family if this bill were to pass.

1. Medicaid Funding

“[T]he Senate bill would radically restructure all parts of Medicaid—not just the expansion provided under the Affordable Care Act.” ¹

“The cumulative impact: a $772 billion spending cut over 10 years, versus current law, and 15 million fewer people enrolled in Medicaid in 2026.” ²

2. Essential Health Benefits

“But another change might have more far-reaching effects: eliminating the Affordable Care Act’s ‘essential health benefits,’ or EHBs. That shift could affect almost everybody, including the 156 million Americans who receive health coverage through their employers.” ⁵

Here’s a rundown of what they are: ^{4, 5, 6}

• Outpatient care — scheduled doctor visits, (outpatient care you get without being admitted to a hospital)
• Emergency room trips — ER visits and ambulance trips.
• In-hospital care — All care people get as hospital patients, such as surgery.
• Pregnancy, maternity and newborn care — before and after birth
• Mental health and substance abuse disorder services — (this includes counseling and psychotherapy)
• Prescription drugs
• Rehabilitative services and habilitative services – help recovering from an injury or illness, but also treatment (therapy) for kids with autism or cerebral palsy.
• Lab tests
• Preventive services — vaccines, cancer screenings, etc.
• Pediatric services — including dental and vision care for children.

3. Pre-existing Conditions Protections

“The BCRA retains the popular ACA provision that people with pre-existing conditions cannot be charged more for insurance because of their health status. However, weakened essential health benefits would hurt people with pre-existing conditions.” ¹

“The Senate bill would retain some limits. It wouldn’t, for example, allow states to waive the prohibition on discriminating on the basis of preexisting conditions. But it would allow states to remove caps on out-of-pocket spending for exchange plans.” ³

4. Subsidies & Taxes

“One major difference is that the Senate bill provides subsides only up to 350% of the federal poverty level starting in 2020; the ACA currently provides subsidies up to 400%. In other words, while individuals earning up to $47,550 qualify for help under the ACA, only those earning up to $41,580 would qualify under the Senate plan. This means far fewer people will qualify for aid.” ¹

Sources:

¹ 4 Things to Know About the Senate’s Health Care Bill

²  4 ways you probably didn’t know the Republican bill changes Medicaid

³  Crazy Waivers

⁴ What Are ‘Essential Benefits’ in GOP Health Care Bill Debate?

⁵ The 10 ‘essential’ benefits that could be eliminated under the GOP health care plan

⁶ What Marketplace health insurance plans cover