If the American Health Care Act recently passed by the U.S. House of Representatives becomes law, states will have the option of removing the pre-existing health protections currently included in the Patient Protection and Affordable Care Act, also known as Obamacare.

Under Obamacare, health insurance plans must accept all applicants regardless of their previous health or disability and cannot use prior health conditions when setting premiums for individuals or small employers. According to the recently released Congressional Budget Office report, which examined the new House bill, states that removed those protections would see their less-healthy residents facing extremely high premiums or loss of coverage. This would disproportionately affect people with disabilities.

The Americans with Disabilities Act does not cover pre-existing condition clauses contained in health insurance policies, even though such clauses can adversely affect people with disabilities more than others.

A Kaiser Family Foundation study found that 27 percent of adults under the age of 65 have health conditions that, prior to the Affordable Care Act, would have rendered them uninsurable if they had sought individual coverage.

The Republican health plan would appropriate $8 billion for state high-risk insurance pools in an attempt to meet the needs of those who may be excluded from the health insurance market, but this might not be enough, according to Paul Melmeyer, director of federal policy at the National Organization for Rare Disorders. Melmeyer recently told the New Republic that to fully fund state high-risk pools, upwards of $300 billion per year would be needed.

The Kaiser Foundation also found that nearly all state high-risk pools excluded coverage of pre-existing conditions for medically eligible enrollees for up to 12 months and limited enrollment based on the pool’s funding. And high-risk pools had significantly higher insurance premiums, typically up to twice as much as available in the market place, Kaiser said.

In a recent CNN report, Andrew W. Gurman, president of the American Medical Association said, “The history of high-risk pools demonstrates that Americans with pre-existing conditions will be stuck in second-class health care coverage — if they are able to obtain coverage at all.”

Even pregnancy is considered a pre-existing condition, which prior to the ACA resulted in women being charged substantially more for health insurance than men, despite the fact that many plans didn’t cover maternity care, according to a National Women’s Law Center study in 2013.

Kelly McGrory, a 28-year-old mother of three from Santa Fe who works as a Hair Stylist at Just Cuts, said her monthly insurance premiums of $500 under Obamacare were lower and her family’s health benefits were better than she previously had under a former employer’s health policy.

While Obamacare has faced complaints nationwide, largely because of rising health insurance premiums, a 2016 study by the Urban Institute found that the average national unsubsidized premiums in the Affordable Care Act exchanges were actually 10 percent lower than the full premiums in the average employer plan.

The current health law requires employers to provide health benefits. Under the new legislation, this mandate would be dropped. Therefore, if you leave a job, it may become more difficult in the future to find an employer who provides health benefits.

A former employee would have the right to stay on an employer’s health insurance for up to 18 months under COBRA — the Consolidated Omnibus Budget Reconciliation Act — but it is expensive. Those needing COBRA would pay 102 percent of the actual cost, with no employer contribution, which could double an individual’s monthly out-of-pocket insurance expenses.

Additionally, individuals with disabilities working in states that expanded Medicaid under the Affordable Care Act who were able to work and earn more money without losing their health benefits may have to reduce working hours or stop working altogether if states are forced to curtail their expanded coverage for working adults.

According a 2017 study published in the American Journal of Public Health, significantly more individuals with disabilities were employed if they lived in a state like New Mexico, which expanded Medicaid eligibility rules.

Andy Winnegar has spent his career in rehabilitation and is based in Santa Fe as a training associate for the Southwest ADA Center. He can be reached at a@winnegar.com.

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