A storm is coming to the United States if her people’s health care is maligned by congressional Republicans and the Donald Trump presidential administration, private sector experts say. The effort to pass the American Health Care Act and gut the Affordable Care Act in the federal budget failed, there is still plenty of talk from lawmakers with regards to repealing or replacing the ACA. A GOP bill that on May 4 passed the House threatens the law.
Even people with plans secured through an employer – 150 million diligent Americans – would lose key provisions to their health care currently available through the Affordable Care Act. Among them: coverage of the 10 essential benefits, treatment for mental health and substance abuse issues, community and age ratings, cost of coverage for pre-existing conditions, removal of annual and lifetime maximums and copays for preventative care, and coverage of children to the age of 26 on a parent’s plan.
These are just a few of many important protections within the ACA that protect us all, provide us with much needed levels of coverage and give us a leg to stand on when those committed to the task of challenging insurance companies, holding them accountable for not honoring insurance contracts. The current administration has not addressed what will happen to employer-sponsored plans if the ACA is repealed.
“Our legislators are leading us to believe that employer-sponsored plans will not be affected and that the employer market is safe,” said Whitney Duhaime, Vice President of Denials Management, a Salt Lake City, Utah-based health care and insurance advocacy firm. “Your benefits are not safe. Your employer insurance plan will lose so much if the current bill passes. Moreover, you will be paying more money for less benefits and protections.”
A primary concern is that insurance companies are wrongfully denying those with mental illness and substance abuse issues. This should be at the forefront of our federal legislators’ concerns considering our state’s opioid and teen suicide rates being among the highest in the nation. The Affordable Care Act extended the Mental Health Parity and Addictions Equity Act to small employer group and individual plans, which says that an insurance company must treat any behavioral health care as medical care. But insurance companies often disregard the provision.
The majority of Americans and three out of five Utahns get insurance through an employer, but when Duhaime met with every Utah federal representatives’ office, none were knowledgeable about the types and extent of consumer protections that exist in these employer health plans. The congressional staffers Duhaime spoke with either did not know about the Parity Act at all or were unaware it had anything to do with the ACA. Furthermore, a general lack of concern was shown regarding how the current congressional attack on health care would negatively impact such a high number of people.
“This is very concerning. We want to make sure that Americans are aware of what they stand to lose with regard to their employer sponsored insurance plans,” Duhaime said. “We are not totally safe within the employer market. We will lose many benefits and consumer protections if this new law is passed. That is unacceptable.”
Duhaime has learned at the highest level of industry that if the 10 essential health benefits are not mandated under the new AHCA legislation, employer plans will not have them. Thus, if the essential health benefits are removed on a national level, they will be removed at the employer level. Even Utah’s federal representatives, who have the job of dealing with federal health care reform, who have also been supportive of rolling back the law, do not know that.
“Our representatives will continue to manipulate us in regards to health care reform as long as we are silent on the issue,” Duhaime said. “But if all 150 million of us called our representatives and said, ‘I don’t want to lose protections for pre-existing conditions’ or ‘I don’t want to lose maternity care, mental health care and emergency room coverage on my employer plan,’ we could make a huge impact.”
“Our federal representatives and special interest groups are betting that we don’t know what we stand to lose,” Duhaime remarked. “It’s time we prove them wrong.”
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