For Nancy Nally, the mother of an autistic 14-year-old with rheumatoid arthritis, there are health concerns that can be remedied with therapy or a doctor’s visit. And then there are those that are out of reach.
Like the estimated 3.1 million Floridians with pre-existing conditions, Nally is worried about the future of health care as Congress considers changing many of the health insurance laws that bar insurers from charging sick people higher rates for coverage.
The U.S. House passed a GOP-backed bill aimed at taking the burden of health care costs off the federal government and giving states more flexibility. The draft legislation, called the American Health Care Act, would allow states to abandon a system that guaranteed consumers wouldn’t be denied coverage or priced out of the insurance market if they’re already sick.
States that receive a waiver would instead offer high-risk pools and subsidy payments to insurance companies.
The potential changes have stirred fears nationwide and in Volusia and Flagler counties. Nally, the 46-year-old Palm Coast mother, said she’s even more anxious about another provision that could restore caps on annual and lifetime benefits.
“If they try and take away the ban on lifetime caps, which is in that legislation, my daughter is going to be screwed,” Nally said. “With the bills that she’s currently racking up, she’d hit a million-dollar lifetime cap maybe by the time she’s old enough to vote. And then she’d be uninsurable for the rest of her life.”
Nally’s concern doesn’t end there. She has lupus and buys her health coverage from the federal exchange created by the Affordable Care Act under Barack Obama. Before the health law was passed, she said no one would insure her or the policy would be too pricey.
The chronic disease occurs when the body’s immune system attacks other organs and tissue. Nally’s is a relatively mild condition marked by episodic flare-ups, she said. It’s also costly because there’s constant testing to monitor it.
“I have literally been hung up on multiple times in midsentence by insurance agents who cold called me looking for new customers. I wasn’t worth their time,” said Nally, who is self-employed.
The bill is expected to be revised in the U.S. Senate since the House didn’t wait on a cost estimate from the Congressional Budget Office before voting on the bill May 4. The federal agency concluded in a report that if passed, the bill would result in 23 million more uninsured people by 2026 and decrease the federal deficit by $119 billion.
It’s a stark contrast from the current trends. The number of people with insurance coverage is at an all-time high thanks to Medicaid expansion in some states and government subsidized insurance everywhere. But there have also been steep premium increases and pricier deductibles for policies offered on the exchanges.
Republicans believe their plan will help relieve some of the pressure.
Rep. Ron DeSantis, R-Palm Coast, said the analysis in the latest CBO report was “fatally flawed” because it projected growth in enrollment on the exchanges when premiums have been rising.
“In the real world, insurance premiums are increasing and the Obamacare exchanges are hemorrhaging participants,” DeSantis said through a spokesperson, “yet, according to CBO, the exchanges will see an almost 100 percent increase in enrollment by 2018, forming the baseline for its coverage estimates.”
If passed, Gov. Rick Scott, who has been a vocal critic of the health law, will get the final say on how Floridians will be affected. Earlier this year, the Agency for Health Care Administration volunteered to be one of the first states to participate in a Medicaid reform effort crafted under a previous version of the bill that failed to come up for a vote in the House.
Recently diagnosed with high cholesterol, Terry Desjardins, 55, of Deltona said she fears a change in the law could leave her without health coverage again. The mother of three said after being laid off in 2010, she ended up in the emergency room and couldn’t pay the bill.
Doctors want her to come back and have another blood test for diabetes because her sugar was so high, Desjardins said. Because she’s vegetarian, Desjardins thinks it might be hereditary.
“I’m afraid to go back,” she said. “I’m afraid if this (law) goes through that I won’t be covered for things like diabetes and high cholesterol and hypertension.”
Today the law allows insurance companies to charge older participants only three times as much as the youngest, which makes premiums cheaper for older people. The Republican plan would eliminate that provision, allowing insurers to charge their oldest customers up to five times as much as their youngest ones.
Studies have shown this provision would raise premiums for a 64-year-old from $8,500 to $10,600, while reducing premiums from about $2,800 to $2,100 for a 24-year-old.
Finally, the Republican plan supports a high-risk pool, an insurer of last resort for people with the highest medical expenses.
Florida started one in 1983 and then closed enrollment in 1991. Health policy experts say one of the drawbacks is that high-risk pools only isolate the high medical costs but health care remains expensive.
“There’s nothing wrong with the idea of a public program that would just take on certain high-cost people as long as it’s run well enough that it can actually serve those people,” said Karen Pollitz, a senior fellow at the Kaiser Family Foundation.
But most states ended up with a long waiting list, Pollitz said.
The House bill dedicates $8 billion over five years for the high-risk population that could be priced out of coverage if states opt out of the current system. Pollitz said that amount is about what it took to cover 200,000 people across 35 states six years ago when temporary high-risk pools were established before the Affordable Care Act went into effect.
“Eight billion sounds like a lot of money, but it isn’t when you’re talking about a population of people whose claims could be well into the six-figures every year,” Pollitz said. “It just won’t pay very many medical bills.”