We've received hundreds of responses to our callout for questions about the Senate Republicans' proposed overhaul of the Affordable Care Act. Earlier this week, we answered questions about continued coverage for serious health conditions and insurance premiums for older adults. Today, we begin with a question from a young adult who says he's excited about the potential repeal of Obamacare.
Q: I'm a 29-year-old who lives in Minneapolis. I purchased my insurance through the exchange for 2 1/2 years. What started to concern me were the increasing premiums that started to feel out of proportion with my actual true costs of health care.
I don't qualify for a subsidy, and I went from paying maybe $120 a month to paying somewhere in the neighborhood of $300 to $400 a month for health coverage. And I was seeing the doctor once a year for a checkup, and other than that, would not step inside a doctor's office.
-- Jordan Myers, Minneapolis, Minn.
A: Jordan is right to be optimistic. Under the Senate's draft bill, Jordan's costs may go down.
The Affordable Care Act says an insurer can only charge older people three times what they charge young people for comparable coverage. The Senate plan loosens those restrictions, allowing insurance companies to charge people over the age of 50 five times what they charge people in their 20s.
The hope is that prices for those so-called "young invincibles" will go down enough that more of them will decide it's worth the money to buy insurance. And the extended hope is that will cut prices for everybody, because more young people like Jordan, who don't use much health care, will be paying into the system.
It's important to note that the vast majority of people who buy insurance on the Affordable Care Act exchanges do get subsidies, so they aren't paying premiums as high as Jordan is.
Q: I'm the mother of two teenage boys, ages 13 and 14. My children may have a disease called left hypertrophic cardiomyopothy.
It's a disease that killed my maternal grandfather at the age of 52. It killed my mother at 52, and my brother had a heart transplant at the age of 51 and 9 months.
I've been asked by our cardiologist to have them genetically tested to see if we can indicate the disease. I'm refusing for the only reason that if they are positive for this disease, they will then have a pre-existing condition that may exclude them from health care later on.
It seems like a ludicrous decision that I'm having to make, but it's one I have to take seriously.
-- Amy Meyer, Corona, Calif.
This is such a difficult situation because of the frightening medical issues and the uncertainty over how the health care system may change.
One of the major aims of the Affordable Care Act — really, a core reason that it exists at all — is that insurance companies used to routinely refuse coverage to people who had been diagnosed with a medical condition.
And often, if they did offer coverage, it would include exceptions for pre-existing medical conditions.
The Senate health bill keeps those protections in the federal law, requiring insurance companies to offer policies to those with pre-existing medical conditions.
However, it then provides a giant loophole for states that want to loosen regulations on insurers. States can seek waivers for many of the Affordable Care Act consumer protections, including the so-called essential health benefits, or the list of things an insurance company has to pay for to be considered legal under Obamacare. The list includes prescription drug coverage, mental health care and maternity care.
So with such a waiver, an insurance company would have to write a policy for someone with a pre-existing condition, but those policies would not necessarily pay the costs of treatment for some conditions. For example, a policy could cover doctor and hospital visits, but if it doesn't pay for prescription drugs, it may not help a cancer patient who needs expensive medicine.
Q: There's an important part of the health care bill that usually gets left out of the reporting on this issue: the tax cuts. How much does one have to make to benefit from the tax cut aspect of this bill?
-- Pam Tellew, Albany, Calif.
A: There are about a dozen taxes that are part of the Affordable Care Act, and the Senate bill proposes repealing all of them. Most are taxes on corporations such as insurance companies, medical device companies, and tanning salons. Republicans argue that those taxes raise costs for all health care consumers, and therefore everyone will benefit if they are repealed.
There are two specific taxes on individuals. The first is a surtax of 0.9 percent on the income of single people who earn more than $200,000, or married couples who earn more than $250,000.
In addition, there's an additional 3.8 percent tax on investment income for people in those same income ranges.
ARI SHAPIRO, HOST:
Senate Republican leaders have said that today would be the day they'd have their health care bill rewritten, but most senators have already left Washington for the July Fourth recess. A tweet from President Trump this morning complicated their work. He said Republicans should immediately repeal the Affordable Care Act and replace it at a later date. The current bill gets rid of big parts of Obamacare, eliminates most of its taxes and shrinks Medicaid dramatically.
ROBERT SIEGEL, HOST:
We asked what was on your mind about the Senate proposal, and we heard from hundreds of you. NPR health policy correspondent Alison Kodjak is with us now to sort through a few more of those comments and questions. Good to see you again, Alison.
ALISON KODJAK, BYLINE: You too. Thanks, Robert.
SIEGEL: And we're going to hear first from Jordan Myers. He's 29 years old. He's in Minneapolis. And when he was no longer eligible for insurance on his parents' plan, he bought insurance for himself on the exchange.
JORDAN MYERS: I purchased my insurance through the exchange for two and a half years. And what started to concern me was the increasing premiums. I went from paying maybe $120 a month to paying somewhere in the neighborhood of $300 to $400. And I was seeing the doctor once a year for a checkup and other than that would not step inside of a doctor's office.
SIEGEL: Alison, Jordan describes his monthly cost for insurance tripling during that time. First of all, was that a typical experience for a young, healthy person buying health insurance through an exchange?
KODJAK: Well, it's not that unusual to have had your premiums go up that high, especially if you're young. Across the board on average, premiums top-line have doubled. But most people - Jordan's an exception here. Eight-five percent of people who buy insurance on the exchanges get subsidies to help offset those premiums.
SIEGEL: Let's say that Jordan has to go back to the exchange. In fact, he's gotten a job that actually has health insurance that goes along with it. Let's say he goes back. How would the Senate bill change things for him?
KODJAK: For someone like him, the Senate bill actually could be good news. The bill changes how insurance companies are allowed to charge for insurance. They're allowed to charge older people up to five times more than younger people instead of three times. So the hope is that for people like Jordan known as young invincibles, the kind of people who you really want to get into these exchanges - their costs will go down. More of them will buy insurance because they'll see value in it.
SIEGEL: It's his parents whose policy may go up, is what you're telling me.
KODJAK: (Laughter) Exactly.
SIEGEL: (Laughter) OK. Our next listener is anxious about the possible removal of protections for those with pre-existing conditions.
AMY MEYER: Hi. This is Amy Meyer. I'm from Corona, Calif. I'm the mother of two teenage boys, ages 13 and 14. My children may have a disease called left hypertrophic cardiomyopathy. It's a disease that killed my maternal grandfather at the age of 52, killed my mother at the age of 52, and my brother had a heart transplant at the age of 51 and nine months. I've been asked by a cardiologist to have my children genetically tested to see if we could indicate the disease. But I'm refusing for the only reason that if they are positive for this disease, they will then have a pre-existing condition that may exclude them from health care later on.
SIEGEL: Just a terrible decision weighing on Amy Meyer, Alison. First, are her worries well-founded? Might a diagnosis of her sons be defined as a pre-existing condition?
KODJAK: Well, they definitely could. And that's a real concern. One of the big things the Affordable Care Act did was it ended the practice of insurance companies being able to refuse to cover people who had medical conditions. The Senate bill does keep the language that says insurance companies have to offer policies to people with pre-existing conditions like these boys could have.
KODJAK: But they added a really big loophole. It allows states to opt out of this long series of consumer protections that are included in the ACA. And one is a list of benefits insurance companies have to offer. And they include hospitalization. They include prescription drug coverage, mental health care or maternity care. And so if a state opts out, you could end up with a policy that technically, like, covers your cancer treatment but doesn't pay for your cancer medication. And so that really can change the idea of being protected for your pre-existing conditions.
SIEGEL: A lot of people wrote to us asking about the taxes that were introduced by the Affordable Care Act, most of which the - if not all of which the Republicans say they'd like to undo. How rich do you have to be to be one of those rich people who's being taxed by the Affordable Care Act?
KODJAK: You have to have a pretty good income - if you're an individual, $200,000 - a couple, $250,000. And then you get taxed on your income above that amount. And also there's a tax on investment income above $250,000. And those along with a lot of corporate taxes have helped to pay for the Medicaid expansion. They've helped to pay for those subsidies that help people buy insurance.
SIEGEL: You're already being taxed on that income at the marginal rate. How much more are you taxed under the Affordable Care Act, an extra percent? Or...
KODJAK: It's an extra percent for your income, an extra 3.9 for your investment income.
SIEGEL: Now, one listener wrote in and said that many people just aren't following what's happening in Congress because they're covered by their employers, and they think that they'll be unaffected. And listener David Hayes wants to know if that's true.
KODJAK: Well, not completely true. People who have employer health insurance should be paying attention. The Affordable Care Act requires employers of a certain size to offer coverage to their employees, and this bill takes away that mandate. And in addition, some of the consumer protections that are in the Affordable Care Act that now actually apply to employers may not if states take those waivers because employers can choose which state to follow in terms of their requirements.
SIEGEL: So you might find yourself in a state where, say, your employer has been able to offer insurance that doesn't cover maternity care, doesn't cover obstetrics.
KODJAK: Exactly. Or you know, if there's one thing that we hear a lot about is this lifetime limits. People will have a limit on how much they can get in terms of medical benefits over their lifetime. Those are gone under the Affordable Care Act. They could potentially come back as well.
SIEGEL: That's NPR health policy correspondent Alison Kodjak. Thanks so much.
KODJAK: Thanks, Robert. Transcript provided by NPR, Copyright NPR.