Note: The AHCA or Trump care was passed by the House on May 4th, 2017 which modifies the ACA (Affordable Care Act aka Obama Care)
Are past injuries counted as pre-existing conditions under the AHCA?
The political battle continues as Republicans attempt another fight to push their proposed healthcare bill, the American Health Care Act (AHCA), through Congress and then to the President’s desk. Millions of Americans who have pre-existing conditions will be affected. This item of the healthcare bill was a major protection under Obama care and continues to be debated among healthcare lobbyists and politicians. Personally, I do not understand the debate. Healthcare coverage that does not cover all of your health needs is really not healthcare at all. Sadly, not all politicians agree. But if you, or a loved one, has been in a prior accident and have a pre-existing back, neck, or head injury or any other injury from an accident, this article contains import information for you. If you disagree with anything in the proposed bill, I urge to voice your concerns to our state legislators. They can be reached as follows:
Senator Dean Heller
Offices: Las Vegas / Reno / Washington D.C. (addresses)
Phone: 702-388-6605 / 775-686-5770 / 202-224-6244
Fax: 702-388-6501 / 775-686-5729 / 202-228-6753
Email: Online Contact Form
Congresswoman Dina Titus – 1st District of Nevada
Congressman Mark Amodei – 2nd District of Nevada
Offices: Elko / Reno / Washington D.C. (addresses)
Phone: 775-777-7705 / 775-686-5760 / 202-225-6155
Fax: 775-753-9984 / 775-686-5711 / 202-225-5679
Email: Online Contact Form
Most civilized countries provide Healthcare for their people. In fact, the US is one of the few that does not. It seems obvious that study of the systems in other nations could be precedent for structuring our own system to provide healthcare to all Americans regardless of income. Most of our allies and even our enemies provide healthcare for their citizens. Many democratic nations have determined and implemented a system to provide Healthcare to all of their citizens.
Below is a table that lists all nations who provide healthcare to all their citizens regardless of the condition being treated:
|Country||Start Date of Universal Health Care||System Type|
|Click links for more source material on each country’s health care system.|
|New Zealand||1938||Two Tier|
|United Kingdom||1948||Single Payer|
|United Arab Emirates||1971||Single Payer|
|South Korea||1988||Insurance Mandate|
|United States||Currently yes||Insurance Mandated|
THE QUESTIONS MOST PEOPLE ARE ASKING UNDER THIS BILL ARE:
- Will Trump care cover pre-existing conditions?
- If you have a pre-existing condition, how will your health plan change under the proposed bill?
In short, the AHCA does not eliminate coverage for pre-existing conditions. Like the Affordable Care Act, Trump care will require all health insurers to cover people who apply regardless of their medical history. But there are some key differences in coverage under Trump care vs. the current law.
Is there a requirement to maintain health insurance or pay a penalty tax?
Answer: NO. The proposed bill eliminates the tax penalties that the Obama Care (ACA) imposes on nonexempt individuals for not having health insurance, as well as employers with 50 or more full-time workers who do not offer health insurance to their employees.
Do insurance companies have to offer coverage regardless of pre-existing conditions?
Answer: Yes, but it’s complicated!!! There is a penalty for not having continuous coverage. Under both the ACA and the GOP bill, insurers are not allowed to deny coverage to any person due to health status. Under the proposed GOP bill, they can charge up to a 30% higher premium for one year, regardless of health status, to those potential insureds who did not have continuous coverage, which is defined in the bill as a lapse of coverage of 63 days or more over the previous 12 months. What???? That means that if you have a past injury, you’ll pay a lot more.
Will young adults under the age of 26 still be able to remain on their parents’ plans?
Yes. The bill does not affect this provision of the ACA.
Is there still going to be an expansion of Medicaid?
Answer: NO. It will be phased out. The legislation ends the enhanced match rate for Medicaid expansion for new enrollees starting in 2020. Those insureds already in the program could stay as long as they remain continuously insured under the Medicaid program. States that have not already expanded Medicaid would not be allowed to do so, starting immediately.
States could also require able-bodied Medicaid recipients to work, participate in job training programs or do community service. Before Obama Care (ACA), Medicaid was available to groups including qualified low-income families, pregnant women, children and the disabled.
Obama care expanded eligibility to all individuals under age 65 who earn up to 138% of the federal poverty level (about $16,643 a year for an individual), but only in states that opted for the expansion. Thirty-one states and the District of Columbia have opted in to the expansion, which includes enhanced federal funding, so far. More than 11 million newly eligible adults had enrolled in Medicaid through March 2016, according to an analysis by the Kaiser Family Foundation of data from the Centers for Medicare & Medicaid Services.
Under the Republican health care plan, no new enrollment can occur under this Medicaid expansion after Dec. 31, 2019. States that have yet to opt in to the expansion by that date also will not be able to do so afterward.
Although the bill doesn’t eliminate the Medicaid expansion coverage for those who are enrolled prior to 2020, if they have a break in coverage for more than one month after Dec. 31, 2019, they won’t be able to re-enroll (unless a state wanted to cover the cost itself). This is a harsh rule given that if someone is injured and can’t work for a month, they could lose their benefits. At Hunt Law Offices, we can help injured people from losing their benefits.
The Republican plan includes another significant change to Medicaid. It would cap the amount of federal funding that states can receive per Medicaid enrollee, with varying amounts for each category of enrollee, such as children, and the blind and disabled. Currently, the federal government guarantees matching funds to states for qualifying Medicaid expenses, regardless of cost. This is an extraordinary change that could adversely affect many families of handicap children and adults by cutting desperately needed benefits.
Are insurers forced to cover certain conditions?
Yes. The bill keeps the essential health benefits requirement under the ACA. Insurance companies would still have to cover 10 health services, including maternity coverage, prescription drugs and mental health care. However, state Medicaid plans are not subject to this requirement after Dec. 31, 2019.
How does the bill affect abortion?
The bill puts a one-year freeze on funding to states for payments to a “prohibited entity,” defined as one that, among other criteria, provides abortions other than those due to rape, incest or danger to the life of the mother. This directly impacts groups like Planned Parenthood. It should be noted that additional funding for education, food, daycare, etc. is not mentioned anywhere for births of these children. Planned Parenthood under Medicaid, currently receives government funding. Also under the GOP plan, tax credits can’t be used to purchase insurance that covers abortion beyond those three exceptions.
Are there subsidies aka Tax Credits to help people buy insurance?
Answer: YES. There are two types of financial assistance under the ACA: premium tax credits (which would change under the new GOP plan) and cost-sharing to lower out-of-pocket costs (which would be eliminated under the GOP plan).
Under the GOP plan, Premium tax credits would be available to individuals who buy their own coverage on the individual, or nongroup, coverage. But instead of a sliding scale based on income, as under current ACA, the Republican plan’s tax credits are based on age, with older Americans getting more. However, the plan allows insurers to charge older Americans up to five times more than younger people, so this is really not a benefit as the GOP claims.
There are income limits under the GOP bill. People earning under $75,000, or $150,000 for a married couple, in modified adjusted gross income, get the same, fixed amounts for their age groups — starting at $2,000 a year for those under age 30, increasing in $500 increments per decade in age, up to $4,000 a year for those 60 and older. The tax credits are capped at $14,000 per family, using the five oldest family members to calculate the amount. This new structure would begin in 2020, with modifications in 2018 and 2019 to give more to younger people and less to older people. Confused yet? Just wait!!!
For those earning above those income thresholds, the tax credit is reduced by 10% of the amount earned above the threshold. For instance, an individual age 60 or older earning $100,000 a year would get a tax credit of $1,500 ($4,000 minus 10% of $25,000). The ACA tax credits also take into account the local cost of insurance, varying the amount of the credit in order to put a cap on the amount an individual or family would have to spend for their premiums. The Republican plan doesn’t do that. (See this explanation from the nonpartisan Kaiser Family Foundation for more on how the ACA tax credits are currently calculated.)
The cost-sharing subsidies available now under the ACA will be eliminated in 2020 under the GOP plan. Small-business tax credits would come to an end in 2020.
What does the bill do about health savings accounts?
The GOP bill increases the contribution limits for tax-exempt HSAs, from $3,400 for individuals and $6,750 for families to $6,550 and $13,100, respectively. The GOP plan allows individuals to use HSA money for over-the-counter drugs, something the ACA had limited to only over-the-counter drugs for which individuals had obtained a prescription.
Who Does This Affect?
Both the current law and the Republican proposal primarily impacts the individual market, where 7% of the U.S. population buys its own health insurance. The GOP plan allows a wider span in pricing based on age by allowing Insurers can charge older individuals up to five times as much as younger people, and states can change that ratio. Under Obama Care (the ACA), the ratio was 3:1.
Older Americans do get higher tax credits than younger Americans under the Republican plan, but whether that amounts to more or less generous tax credits than under the ACA depends on other individual circumstances, including income and local insurance pricing. Those with low incomes could do worse under the GOP plan, while those who earned too much to qualify for tax credits under the ACA (an individual making more than $48,240) would get tax credits.
I urge you to review the Kaiser Family Foundation’s interactive map to see how tax credits may change, depending on your individual circumstances. “Generally, people who are older, lower-income, or live in high-premium areas (like Alaska and Arizona) receive larger tax credits under the ACA than they would under the American Health Care Act replacement,” KFF says. “Conversely, some people who are younger, higher-income, or live in low-premium areas (like Massachusetts, New Hampshire, and Washington) may receive larger assistance under the replacement plan.”
Which ACA taxes go away under the GOP plan?
Many of the ACA taxes would be eliminated. The bill eliminates all fines on individuals for not having insurance and large employers for not offering insurance. Also, beginning in 2018, for high-income taxpayers, the bill eliminates the 3.8% tax on certain net investment income and the 0.9% additional Medicare tax on earnings above a threshold. That same year, the bill repeals the 2.3% tax on the sale price of certain medical devices and the 10% tax on indoor tanning services. It also eliminates the annual fees on entities, according to the IRS, “in the business of providing health insurance for United States health risks,” as well as fees on “each covered entity engaged in the business of manufacturing or importing branded prescription drugs.”
It reduces the tax on distributions from health savings accounts (HSAs) not used for qualified medical expenses from 20% to 10% and the tax on such distributions from Archer medical savings accounts (MSAs) from 20% to 15%. It lowers the threshold for receiving a tax deduction for medical expenses from 10% to 7.5% of adjusted gross income. And from 2020 through 2024, the bill suspends the so-called “Cadillac tax,” a 40% excise tax on high-cost insurance plans offered by employers.
I urge readers to follow this proposed law and voice your opinions. It is an integral part of Democracy to be heard. Being an attorney, I love protecting people’s rights on a daily basis, including those of my own family and friends. Following our political process and voicing objections is key to keeping to all of our freedoms alive.