3 Benefits Your Employer-Sponsored Health Care Could Lose After Obamacare Repeal

Image courtesy of MeneeDijk

With the House and Senate moving forward with their plan to disassemble the Affordable Care Act through a budget resolution, much of the focus has been on the millions of people who would be affected by losing insurance that they purchase directly through an exchange. However, the ACA also has a number of aspects that benefit Americans who receive insurance through their employer, some of which could be at risk if the law is repealed.

Kaiser Health News (via NPR) takes a long look today at the many ways that employer-sponsored health plans could be affected by repeal. Here are a handful of the most important:

1. Fewer Free Preventive Services

Under the ACA, many insurers are required to provide a variety of preventive care services without charging a copay. This includes everything from vaccines for a wide variety of diseases (measles, tetanus, hepatitis A and B, flu shots, pertussis, and several others), blood pressure and cholesterol screening, and screening for hepatitis C, HIV, syphillis, type 2 diabetes, obesity, colorectal cancer, and depression.

The law also includes a number of preventive services for women, including breast and cervical cancer screening, HPV testing, contraception, and a variety of pre- and post-natal services (folic acid supplements, breastfeeding counseling, tobacco-use intervention).

For children, the ACA mandates no-copay coverage of things like hearing screening for newborns, autism screening for young children, vision screening, among others.

Your insurance might have already provided some or all of these things with no copay before ACA implementation, and it might still cover this services if the ACA is repealed, but it wouldn’t be required to by federal law.

2. Limits On Maximum Coverage; No Limit On Out-Of-Pocket Costs

While most people are lucky enough to have never found this out, many group insurance plans had maximum limits on the amount the insurer would pay over the course of a year or the lifetime of the policy.

The ACA removed those limits on most plans, meaning patients with conditions and ailments that require costly treatment would no longer be left on the hook after surpassing their insurer’s maximum payout amount.

For most people, this is thankfully not a huge problem, but we also rarely know when we’re about to acquire a chronic disease, or find ourselves requiring years of expensive surgery and treatment after being in a car wreck.

Again, repeal would not require insurers to put these limits back in place, but it could allow them to do so.

The flipside of this coin is that the ACA put in place limits on how much insurers could expect policy holders to go out-of-pocket each year. Any coverage costs above that are to be paid by the insurer. These limits could also go away if the repeal effort is successful.

3. Indefinite Waiting Periods

Before the ACA, your employer could determine for itself how long a new employee must wait before being eligible for coverage. Under the ACA, that waiting period is limited to 90 days.

Additionally — though this was not terribly common for group insurance plans — the ACA prohibits employers from having a waiting period for covering pre-existing conditions.

It’s still not known exactly how expansive the ACA repeal effort will be. Full repeal of the law would have difficulty making it through Congress, as that would require 60 votes in the Senate. That is why the GOP is attempting a piecemeal repeal via a budget resolution, which only needs a simple majority in the Senate to pass.

Under the Obama administration, the GOP made dozens of legislative attempts to overturn the ACA. The plan that got the farthest was a 2015 budget resolution penned by Rep. Tom Price (GA) that made it all the way to the White House before being vetoed in early 2016.

Rep. Price is also President-elect Trump’s nominee for Secretary of Health and Human Services, which would put him in charge of Medicare, Medicaid, and the Food and Drug Administration, among others.

The President-elect has promised a replacement for the ACA, but has yet to provide any substantive details on what that plan would look like for consumers other than to say that it will be “insurance for everyone,” and that people will be “beautifully covered.”

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