A few days ago Parents Magazine published a grossly distorted “news” article on the House-passed American Health Care Act, which misinformed readers about the potential effects of the legislation and the state of health care today. This is extremely disappointing, considering families rely on this publication for factual information, not inaccurate rumors. Here are just a few examples of what they got wrong.
Magazines Shouldn’t Ignore Obamacare’s Detriments
First, Parents made no mention of the realities of the current health law’s failure. Of course, some people have benefitted from the Affordable Care Act (ACA), also known as Obamacare, but many have also suffered, and more will suffer if the law is unchanged:
- Soaring premiums: Just this year, premiums increased 25 percent on average for those who buy the ACA plans. More than half (55 percent) of those ACA enrollees are women. Ironically, Parents drives home the point that higher premiums make it harder for people to afford insurance coverage. This is true, and it is already the case under the ACA.
- Cancelled plans: In fall 2013, 4.7 million Americans’ health plans were cancelled because they were not compliant with the ACA, and millions more have lost their plans in the years since. Many more will lose their plans if a new health care law is not passed now.
- Death Spiral: Sadly, one reason more and more Americans will lose coverage under the status quo is that, in the words of Aetna’s CEO, the ACA is in a death spiral. Insurers are exiting markets because they can’t operate under the ACA’s rules. In fact, in one in three U.S. counties, women and families who enroll in the ACA’s exchange plans have only one “choice” of insurer. As more insurers exit, there will be places where enrollees have zero options. Already, 16 counties in Tennessee face this problem for 2018.
How the AHCA Helps People
The Republican health plan isn’t perfect, but it aims to help people who’ve been badly affected by the ACA while also protecting those with pre-existing conditions.
- In contrast to the Parents article, the MacArthur Amendment does NOT “allow states…” to waive “pre-existing condition coverage.” All 50 states will require that every insurer offer a policy to every customer, regardless of his or her health status or history.
- States will be allowed to waive certain regulations. They can waive the “essential health benefits” required of every policy in the ACA. This means that if people want to buy coverage that is more basic—plans that also tend to be more affordable—they will be free to do so. It does not mean that carriers won’t also continue to offer plans with ACA features, but it does give people a choice.
- States can also waive “community rating” rules, which would allow insurance companies to offer prices that reflect applicants’ health status or history that would affect the likelihood of future claims. This waiver program is aimed at lowering premiums, which will result in more people being able to afford to become and stay covered.
- In contrast to the Parents article, the AHCA actually WOULD require states to set up a high-risk pool safety net or participate in a federal safety-net program for those who delay applying until they have a high-cost condition. This is required of any state that wants to waive the “essential health benefits” or “community rating” rules.
- The Parents article fails to mention that the AHCA includes a universal, advanceable, refundable tax available to anyone making under $75,000 annually, and it will increase with age (because older people face higher insurance premiums). This means women and families (and men too) who buy insurance on their own will effectively get a reduction in their monthly premiums equal to the size of their tax credit.
What ‘Pre-Existing Condition’ Means
The Parents article, like too many criticisms of health-care policies, conflates the concept of “pre-existing condition” with any factor that might increase insurance costs. There are many factors in insurance that may lead someone to have to pay more than another person, but that does not mean that he or she has a preexisting condition that makes him or her uninsurable.
Women will NOT end up having to “pay out of pocket” for health care just because they’ve had a pregnancy, or a C-section, or have been treated for postpartum depression, as a doctor quoted in the Parents article implies. Insurers will still offer them coverage—though they may have to pay more than those with the very lowest premiums if they delay applying for coverage or choose to change plans when they are already pregnant or in need of impending treatment. But importantly, many women will likely have more affordable options for insurance under the AHCA, allowing them to get a policy before they develop a condition or become pregnant.
Women generally consume more health care than men do, which is why before the ACA, women’s premiums tended to be higher. The ACA erased that difference, but everyone’s insurance premiums soared because of the ACA—which was bad news for women, even if it was worse news for men. The AHCA will repeal many of the ACA’s provisions, but it will not repeal the rule that insurers cannot offer someone a higher price just because of gender. Gender-based pricing will still be outlawed.
The AHCA does have protections for those with pre-existing conditions that might otherwise make them uninsurable, or extremely expensive. There are state-based safety nets, but there is also a federal safety net or guaranteed protection fund for those with pre-existing conditions, called the “Federal Invisible Risk-Sharing Program.” This program would allow people with pre-existing conditions to enroll in any insurance plan at the same price as everyone else; it simply allows insurers to pass along most of their premiums into the government fund, which would pay out for most of their claims.
Parents and editors can learn more about how this provision works by reading here.
Readers deserve better than politicized misinformation from magazines like Parents. Tell the editors at Parents Magazine (@parentsmagazine) that readers who really care about health care and good outcomes for people want facts, not fearmongering.