Have Employer Coverage? GOP Proposals Will Affect You Too (Part 2)

Employer-based insurance will also be degraded by the current House and Senate health bills...

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As Senate Republican leaders continue to craft their bill to repeal and replace the Affordable Care Act (ACA), most attention has been focused on the number of individuals who would lose coverage if the legislation is enacted. To be sure, the ACA coverage expansions—through Medicaid and subsidized Marketplace plans—have been a lifeline for millions of people, particularly those who are low income, and have reduced the number of individuals without coverage to record lows. But the legislation that passed the House and the bill now under consideration in the Senate could also affect the more than 150 million people with employer-sponsored insurance (ESI) who gained federally guaranteed protections against catastrophic costs.

Earlier this year, I wrote about ACA reforms that apply to employer-based plans. At the time, we didn’t know yet what GOP repeal plans would retain of the ACA and what would be lost. Now, with the bills under discussion, we know more about what’s at risk for those with job-based plans.

What Protections Can People With ESI Hope To Retain?

Both the House-passed American Health Care Act (AHCA) and the Senate’s Better Care Reconciliation Act (BCRA) leave untouched the requirement that job-based plans cover recommended preventive services without cost-sharing, the prohibition on excluding coverage for pre-existing conditions, and the right to appeal your plan’s denial of care to an independent expert reviewer. The bills also retain the requirement that plans that cover dependents must make that coverage available until they turn 26. However, this latter protection could become illusory. Both bills repeal the requirement that large employers offer coverage to employees and their dependents. Thus, the right to keep a child on a parent’s plan until they turn 26 can only be exercised by those with employers willing to continue offering dependent coverage.

What Are The Risks For People With ESI Who Have Pre-Existing Conditions?

Now let’s look at what might be lost. The biggest risks are for employees with pre-existing and chronic conditions because they can no longer count on comprehensive benefits and the ACA’s protections against catastrophic costs that are tied to those benefits. Both the House and Senate bills allow states to waive the essential health benefits (EHB), the ACA requirement that individual and small employer plans cover 10 categories of services, including services often excluded from coverage prior to the ACA. For people who work for small businesses (fewer than 50 workers), a waiver from EHB would mean skimpier coverage that may exclude key services such as prescription drugs, maternity care, or mental health treatment.