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GlendaWoumb    07 May 2017 07:01
The American Health Care Act, passed by the House on Thursday to cheers from Republican members, would give states wide leeway over a host of provisions that many Americans have come to count on, creating a patchwork of health insurance rules across the nation.

The legislation, designed as a replacement for the Obama-era Affordable Care Act, would allow states to apply for waivers to exempt insurers from providing coverage for 10 Ў°essential health benefits,Ў± including emergency services, maternity care, and mental health treatment, among others. The level of coverage would depend on what each state decides.

It also would permit states to apply for waivers to allow insurers, under certain circumstances, to charge higher premiums to people with pre-existing health problems, something that the ACA forbids.

The AHCA allocates $138 billion over 10 years to fund a Patient and State Stability Fund for states that apply for waivers, an amount experts say is not nearly enough to cover the millions of Americans with pre-existing health conditions.

Granting those waivers would cause premiums to rise and also make it harder for people to get comprehensive coverage, especially those with health problems, says Betsy Imholz, special projects director for Consumers Union, the policy and mobilization arm of Consumer Reports.

Ў°In combination, these features clearly allow states to do away with protections for pre-existing conditions, letting insurers charge our most vulnerable populations more, and to provide skimpy coverage for everyone,Ў± Imholz says.

House Republicans and other conservatives disagree, saying the waivers, which would vary from state to state, could actually lead to lower premiums and give consumers a wider choice of plans.

Reducing regulatory burdens could encourage insurance companies to enter new markets or to modify their existing policies and rates, giving consumers more coverage options, says Edmund Haislmaier, a senior research fellow in health policy studies at the Heritage Foundation, a conservative think tank.

"State governments have performed the basic function of regulating insurance reasonably well for over a century, and there is no need for the federal government to supplant these efforts as it is now doing under Obamacare," Haislmaier says.

While the debate over how to overhaul the ACA continues, many Americans say they are worried about being able to afford good quality medical care. In our CR Consumer Voices Survey conducted earlier this year, 55 percent of Americans said they lacked confidence they or their loved ones would have access to quality, affordable healthcare.

The bill now heads to the Senate, where leaders say the legislation could change dramactically. Then the Senate version must be reconciled with the House.

With the legislation still far from being finalized, itЎЇs hard to predict how many states would seek waivers. But hereЎЇs how it might play out where you live.

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Where Waivers Are Mostly Likely

Some exchanges, like California and Michigan, have robust markets with multiple insurers where things are working well, at least for now, says Chris Sloan, a senior manager in the policy practice at Avalere Health, a healthcare consulting firm. "You're more likely to see waivers in states that are struggling," Sloan says.

States with sticker shock. In 2017, the average insurance premium on the most popular Silver plan on ACA exchanges was 17 percent higher than the year before, according to HealthPocket.com. But in some places, the increase was even sharper. In Arizona and Oklahoma, for example, premiums shot up more than 50 percent.

States with few insurers. One-third of counties in the U.S. have one insurer on their exchange, according to Kaiser Family Foundation. States particularly struggling to attract insurers include Oklahoma, which has only one insurer left, and Tennessee, where 16 counties have no insurer signed up for 2018.

States that didnЎЇt expand Medicaid. A total of 31 states expanded their Medicaid program by taking federal money allocated by the ACA to cover most of the cost. States that didnЎЇt expand MedicaidЎЄmostly states with Republican governorsЎЄended up with more people on the exchanges, including a larger share of sick people.

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