Pros and Cons
of Health Care Reform Blog

May 22

America's Health Insurance-Part 1-The American Health Care Act of 2017-The Winners and Losers

Posted by Dina Collins on Monday, May 22, 2017

The AHCA (aka Trumpcare) has passed the U.S. House of Representatives and is, understandably so, a hot topic. Being an insurance broker for nearly 30 years, I’d like to share my opinions on this matter that’s so vitally important to us all. This blog post is Part 1 in a series that will address the issues.

First, let me set the stage of my overall view on health care reform. I found our pre-ACA (aka Obamacare) system in severe need of repair. Although it produced winners and losers over our pre-ACA system, the ACA was drastically different than my idea for reform. Similarly, the AHCA is also a radical departure from my reform preferences, although it too will produce winners and losers over our current ACA system. But alas, no one in a position of power asked for my opinion.

Let’s start dissecting the AHCA. The winner of the ACA system over the pre-ACA system seems to be those with pre-existing conditions. Is this actually true? Possibly. First, it depends on the state where you live. Here in California, we had a major risk pool for the uninsured (MRMIP), as did many other states. It was subsidized by the state to help keep costs as low as possible. Let’s compare rates. In 2013, a Kaiser MRMIP plan for someone living in Sacramento County cost approximately $452 for a 40-year-old, $573 for a 50-year-old, and $727 for a 60-year-old. This was for a plan that offered low copays, no deductible and a $2,500 maximum out-of-pocket. However, it did have a $750,000 lifetime maximum. For similar coverage through Anthem Blue Cross in a PPO plan, the premium was about $670 for a 40-year-old, $822 for a 50-year-old and $1,246 for a 60-year-old. Now, let’s compare today’s premiums for the similar Platinum Plan ($0 deductible, but $4,000 max out of pocket). Kaiser/Anthem is $514/$708 for a 40-year-old, $718/$989 for a 50-year-old, and  $1,091/$1,504 for a 60-year-old. Looks eerily similar. But remember, we’re comparing rates for those who were declined medical coverage, so they had to go with the MRMIP plan.

Now, let’s compare premiums for those who passed their medical screenings. In 2013, Kaiser would have charged a healthy 40-year-old $451 for similar coverage; $508 for a 50-year-old and $646 for a 60-year-old. Anthem’s rates were a comparable percentage decrease. If we only consider those who couldn’t get coverage previously, who are the winners? You could argue no one wins on that issue alone. However, once we mix in the Advanced Premium Tax Credits and subsidies, we will see more winners. You may be surprised that the biggest losers are people who pass their health screenings. For those who were unable to get coverage in California and who are above 400% of the federal poverty level, it was practically a wash.   Read More