Congressional Republicans are currently trying to reform health care law in the United States by repealing the Affordable Care Act and putting into effect legislation that will impact millions of students and young adults.
The Patient Protection and Affordable Care Act, popularly known as Obamacare or the ACA, is a federal statute signed into law by former president Barack Obama in 2010. The act represents a significant overhaul of the United States health care system and impacts more than 20 million uninsured and underinsured people, especially young adults and students who increasingly make up the newly insured rate.
Among other things, the ACA mandates that every American purchase a health insurance plan or pay a fine. It also restricts health insurance companies from denying insurance to people with pre-existing conditions and states that people can stay on their parents’ plan until the age of 26.
Citing governmental overreach with the individual mandate, Congressional Republicans attempted to repeal the ACA and replace it with the American Health Care Act of 2017 on March 23. The AHCA failed to garner enough votes from House Republicans and was withdrawn.
Now, Republicans are trying to amass votes for new legislation.
Luba Ketsler, a professor of economics at UTD, talked about the significance of the bill.
“The reason the AHCA is important is because this law proved too liberal for some of the ultraconservative Republicans. I think the AHCA is indicative of whatever future replacement the Republicans will have,” Ketsler said.
Ketlser talked about its effect on students at UTD who could lose health insurance either because they cannot afford it or they are too old.
“A student could have an emergency and a medical bill could financially cripple them,” she said.
According to a 2013 study, medical bankruptcies account for the majority of personal bankruptcies in the United States.
2015 census data indicates that young adults made the most significant drop in the uninsured rate, with only 15 percent of 18 to 34 year olds uninsured. This is the third consecutive year where young adults have made a significant drop in the uninsured rate.
The AHCA kept the under 26 clause, but did not keep the individual mandate.
According to Ketsler, individuals who urgently need health insurance will buy it while others who believe they do not need it will not. This will drive up insurance rates for individuals who need it the most.
“It would cost nearly a $178 billion per year to subsidize those high-risk pools for those who get sick often or who are at risk and what Tom Price (the Human and Health Services secretary) is suggesting is only $3 billion over the next three years,” she said.
The rising prices would affect people with more serious conditions.
“With the absence of cross-subsidizing, which is the healthy population paying for these high-risk pools, if the sicker leave that pool, their premiums go up. The Republican plan did not do anything about rectifying the gap in subsidies,” Ketsler said.
Healthy people with insurance would also suffer financially under this plan.
“The Kaiser Family Foundation shows that there will be a 19 percent increase in premiums from our pocket to offset the lack of cost-sharing subsidies,” Ketsler said.
The ACA mandates that insurance companies cannot deny people health insurance based on pre-existing conditions. These conditions include cancer, diabetes and asthma.
Ketsler said young adults with any of those conditions would find it even harder to find affordable insurance alternatives if the ACA is repealed.
Zoee Camille Fowler, an economics senior, is one of those people. She has Type 1 Diabetes and relies on the ACA for affordable insurance.
“The most effective aspect of (the ACA) for me was that insurances could not turn me away or charge me higher premiums just because of my pre-existing condition,” Fowler said.
With the ACA, she gets her own insurance and her premium, because of federal subsidies, is only $24, while her co-pay for doctors’ and specialists’ visits varies from $5 to $25.
She said if she had a lapse in employer-based insurance, an insurance company could skyrocket her premiums.
“I am scared of the uncertainty of this situation. How much everything is going to cost, where I’ll get insurance. It is scary because I am a full-time student and I can only work so much so I don’t know how to afford everything without subsidies,” Fowler said.
Brit Berrett, a clinical professor who heads the healthcare management program for UTD, said the individual mandate portion of the ACA will probably be struck down.
“The mandate required that you have health insurance or your report that you do not. The goal of the ACA (is) that we find the underfunded and the uninsured and provide them with federal programs,” Berret said.
The AHCA tried to strike down the individual mandate and had a less severe version where there is a 30 percent surcharge for people who do not have insurance after 63 days.
Under President Donald Trump, the Internal Revenue Service (IRS) has weakened enforcement of individual mandate violations by making it optional to fill out the tax line reporting one’s healthcare coverage.
Berret had an optimistic view of how the federal government can deal with healthcare without this individual mandate to rein in costs.
“The federal government may award block grants to the state to expand their Medicaid coverage for those that are underfunded and uninsured and were covered under Obamacare,” Berret said.
Ketsler said this would be an unsustainable model because health care costs are continually rising.
“The assumption with those lump sum payments with the block grants is that the costs will not rise, but if health care costs continue to rise, those payments won’t cover health care fully,” Ketsler said.
Berret also said lifestyle choices and noncompliance played a huge part in determining the demand for health care.
“The single most significant determinant of health care costs is lifestyle and behavior, it is not economics, not society, not race or gender, but lifestyle,” Berret said.
But Ketsler said in terms of congenital and long-term disease, students with chronic conditions can still not afford health insurance, or their costs will continue to rise to become a burden.
“Without the (ACA), I would not be able to afford my medicine and my doctor’s visits. If I don’t take care of my health right now, that means down the road I can have amputations, stomach paralysis, I can go blind,” Fowler said. “With the ACA I can afford to take care of myself and stay healthy. I am thankful for that.”