Today, Bethany Gladhill's daughter Beatrix is an active 9-year-old who enjoys dance and school. But right after she was born, Beatrix was diagnosed with a heart valve anomaly. After a family job loss, which meant no more employee health benefits, Gladhill soon found that she couldn't add baby Beatrix to the new health plan she and her husband purchased on the individual market.
Their infant had a "preexisting condition," their health insurance broker told them. The St. Paul couple, who continue to work as consultants, were stunned. Said Gladhill: "It's the honest inability as a parent to believe that nobody cares enough about your newborn to cover them with insurance and there is nothing you can do about it."
Eventually, the family did get coverage for Beatrix through Minnesota's old "high-risk pool" insurance program, but at a cost — they had to buy a separate plan for her with higher premiums, a narrow medical provider network and two annual deductibles totaling around $10,000. After President Barack Obama's Affordable Care Act passed, the couple could finally buy a family plan, one with the same clinics, one set of bills and a deductible of $4,000. "The costs went down by half. It was huge," Gladhill said.
As congressional Republicans work to pass their plan to replace the ACA, it's important to remember that families like Beatrix's could be caught up in one of the legislation's biggest and most objectionable changes. The bill, which regrettably passed the House on Thursday, allows for a return to a reprehensible era when insurers could reject coverage for an infant or anyone else with preexisting ailments.
Assurances from GOP leadership that the newly revised bill would instead provide "multiple layers of protection" for those with preexisting conditions are disingenuous at best. The GOP plan, known as the American Health Care Act (AHCA), proposes that those denied commercial coverage get insurance through high-risk pools — the type of program that Gladhill relied on.
While Minnesota's high-risk pool worked relatively well compared with other states', Gladhill's experience illustrates drawbacks. Premiums are often much higher than commercial rates, causing people to drop out or not sign up. Separate deductibles add to consumer expenses. Some states capped enrollment because of soaring costs. The Minnesota program's claims totaled $298 million in 2013.
The AHCA does propose providing federal funding for new high-risk pools. But experts have concluded that the $130 billion provided over 10 years falls far short of what is needed: $327 billion. Against that backdrop, the revised AHCA amendment adding $8 billion over five years is a pittance. That this addition was enough to get moderate GOP holdouts to vote yes is outrageous. They either don't understand, or don't care, that those who need health care the most may be priced out of coverage.
There are many other reasons to oppose the AHCA. One key point: Insurers would also be allowed to charge older people more and the bill would provide less tax credit assistance for many of them. In addition, Republicans rushed a vote on the bill Thursday without an analysis on the revised bill from the Congressional Budget Office, meaning it's unclear how many people might lose coverage and how much the bill would cost.
A previous CBO analysis of the unrevised AHCA concluded that 24 million fewer people would be covered than under the ACA by 2026. In addition, $880 billion would be cut over the next decade from the Medicaid program — which provides long-term care for the elderly and medical coverage for more than 30 million children.
The nation's doctors, nurses and hospitals oppose the AHCA. Members of the Senate, where the bill goes next, now need to be the adults in the room. Three members of the Minnesota House delegation — Reps. Erik Paulsen, Tom Emmer and Jason Lewis — disregarded medical providers' advice and voted for this morally bankrupt legislation. They owe Minnesotans an explanation.
Have a question about the AHCA that you'd like the Editorial Board to explore? Send to scottg@startribune.com, along with contact information.
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