Yes, Obamacare affects you too!

As for people thinking, “Well, Obamacare repeal will hurt those on the individual market.  I’ve got a large employer and a good plan.  It’s all good.”  Actually, not so much.  There’s lots of stuff in Obamacare that benefits pretty much everybody with health insurance.  NPR summarizes:

Nonetheless, as tensions grow in Washington over the future of the health law, it is important to understand some of its effects on large-group plans.

No copays for preventive services

The health insurance offered by big companies is typically pretty comprehensive, the better to attract and keep good employees. But Obamacare broadened some coverage requirements. Under the law, insurers and employers have to cover many preventive services without charging people anything for them. The services that are required with no out-of-pocket payments include dozens of screenings and tests, including mammograms and colonoscopies that are recommended by the U.S. Preventive Services Task Force; routine immunizations endorsed by the federal Centers for Disease Control and Prevention’s Advisory Committee on Immunization Practices; and a range of services that are recommended specifically for children and for women by the federal Health Resources and Services Administration…

No annual or lifetime limits on coverage

Even the most generous plans often had lifetime maximum coverage limits of a few million dollars before the health law passed, and some plans also imposed annual coverage limits. The health law eliminated those dollar coverage limits.

Annual cap on out-of-pocket payments for covered services

The health law set limits on how much people can be required to pay in deductibles, copayments or coinsurance every year for covered care they receive from providers in their network. In 2017, the limit is $7,150 for individuals and $14,300 for families.

“Many employers often had an out-of-pocket limit anyway, but this guarantees protection for people with high needs,” said JoAnn Volk, a research professor at Georgetown University’s Center on Health Insurance Reforms, who has written on this issue

No waiting periods for coverage of pre-existing conditions

Prior to the ACA, employers could delay covering workers’ chronic and other health conditions for up to a year after they became eligible for a plan. Under the ACA, that’s no longer allowed. As a practical matter, though, coverage of pre-existing conditions was rarely an issue in large-group plans, say some health insurance analysts.

Repeal could reopen the door to that prohibited practice, however.

If you or someone in your family has a serious medical condition (like, oh, I don’t know, at random, I’ll just pick “rare genetic disease“), those lifetime limits really matter (as do the waiting periods on pre-existing conditions).  Or, say my good friend anxiously awaiting a new kidney.  But, I guess in Paul Ryan’s world, we’re all just takers.

About Steve Greene
Professor of Political Science at NC State

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