How the Proposed Trumpcare Plan Could Change Healthcare Coverage
Healthcare organizations need to keep track of the changes that the American Healthcare Act will bring to patients’ medical insurance coverage.
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Healthcare providers, business and industry groups, and medical billing companies are keenly watching the health insurance scenario to assess the potential impact of the exit of Obamacare and the entry of the American Healthcare Act (AHCA). The media is full of reports about how these changes will affect healthcare and coverage for different groups. Here is a summary of the main changes that the revisions to coverage could bring: •
Higher premiums for those who buy individual health insurance: The Trump administration wants to stop federal cost-sharing reduction (CSR) payments which go to low-income people using the Affordable Care Act marketplace and are different from the federal premium subsidies. Industry and business groups point out that withdrawing CSRs would raise premiums at least 15 percent for everyone who buys individual health insurance.
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Removes individual mandate: The ACHA eliminates Obamacare’s $695 penalty individuals face for not signing up for coverage. Trumpcare allows people to choose not to purchase health insurance, but includes a financial incentive to encourage individuals to maintain coverage: insurers will be able to charge a 30% penalty on those who did not have insurance coverage for 63 continuous days or longer in the previous year.
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Tax credits to replace Obamacare subsidies: The AHCA offers age-based tax credits that start at $2,000 for individuals under age 30, which would rise to $4,000 for those over 60. This will help those who are not covered by their employer. While the credits may not cover the full cost of a plan that pays for routine health care, they could provide protection against a catastrophic health event.
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Changes in coverage of pre-existing conditions: Like the Affordable Care Act (ACA), the AHCA will require all health insurers to provide coverage for people regardless of a pre-existing condition. However, under Trumpcare, states can obtain waivers to allow insurers to charge more for people with pre-existing conditions. Only those with pre-existing conditions who have a gap in coverage would have to pay these higher charges.
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Changes for “essential health benefits”: Under Trumpcare, states can apply for a waiver to exempt insurance plans from including essential health benefits — including maternal care, prescription coverage and mental health care — in their plans. To qualify for the waiver, the states would need to prove they could either lower the cost of health care for people or increase the number of people covered by insurance. Under the ACA, these benefits had to be part of every insurance plan.
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Changes in Medicaid: Trumpcare will roll back the federal support of expanded Medicaid coverage to those earning no more than 133 percent of the federal poverty level. States can choose to receive a set amount per beneficiary or a lump-sum block grant from the federal government. A first for Medicaid: under the AHCA, states could also introduce work requirements for Medicaid. This is expected to ease the burden on the program.
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Rates for older adults vs. younger adults: Under the ACA, insurance companies could charge an older person no more than three times its premium for a younger person with a similar plan. Trumpcare proposed to increase the maximum allowable ratio to 5 to 1. This could raise premiums for older Americans who are not yet eligible for Medicare.
Hospitals and medical practices need to keep track of the changes that Trumpcare will bring to patients’ health insurance coverage. In this period of uncertainty, healthcare providers should seek to stay more competitive and consumer-focused. Outsourcing medical billing and coding is a sure-fire strategy to improve operational efficiency, cash flow, and patient care and satisfaction.
www.outsourcestrategies.com
1-800-670-2809