14 Benefits Americans Will Lose if Health Reform Not Funded
The Republican-controlled House of Representatives plans to “defund” the implementation of the Affordable Care Act as part of their efforts to repeal the health reform law, even as Members of Congress retain these very health benefits and rights for themselves, courtesy of the American taxpayers.
Families USA, a national non-profit, non-partisan Washington-based organization, dedicated to the achievement of high-quality, affordable health care for all Americans, has documented in a new report 14 health care benefits and rights that would be withdrawn, should funding not been forthcoming to implement the health reform law.
The 14 health care benefits and rights that would be withdrawn from America’s families are:
- Affordable health coverage
- Guaranteed coverage, regardless of pre-existing conditions
- A right to appeal claims that are denied by insurers
- Protection against discriminatory premiums due to pre-existing conditions
- A complete package of health insurance benefits
- Guaranteed coverage that can’t be taken away
- A prescription drug benefit with no coverage gap
- Protection against catastrophic health care costs
- A choice of easy-to-compare health insurance plans
- Protection against unreasonable premium increases
- Fair and equal premiums for women
- Coverage for early retirees
- Access to free or low-cost preventive services
- Access to affordable care at clinics
The report points out that Members of Congress and employees of the federal government get health insurance for themselves and their families through the Federal Employees Health Benefits (FEHB) Program. Members of Congress would retain the following for themselves:
Affordable health coverage
Members of Congress receive a subsidy equal to approximately three-quarters of the cost of their health insurance premiums—at taxpayer expense. The Affordable Care Act extends tax credits to American families to provide help with the cost of health insurance premiums.2 Congressional promoters of repeal want to deny hard-working American families this premium relief while keeping the government subsidy that helps them purchase coverage.
Guaranteed coverage, regardless of pre-existing conditions
Every member of Congress and his or her family members are guaranteed access to coverage, even if they have a pre-existing condition like cancer or diabetes. The Affordable Care Act provides this same guarantee of coverage by requiring that insurers offer coverage to all Americans, even if they have a preexisting
condition.4 Promoters of repeal would take this protection away from America’s families.
A right to appeal claims that are denied by insurers
The U.S. Office of Personnel Management (OPM), which oversees the health insurance companies that offer coverage to members of Congress, provides a clear, easy-to-understand process for appealing claims that are denied. Many Americans with coverage through the individual market do not currently have a right to appeal claims that are denied. The Affordable Care Act corrects this by ensuring that Americans have access to a straightforward process for appeals. American families will lose this protection if the Affordable Care Act is repealed.
Protection against discriminatory premiums due to pre-existing conditions
Members of Congress pay the same amount for their coverage whether they are healthy or sick.7 The Affordable Care Act establishes this right for all Americans
by prohibiting insurers from charging people more just because they are sick or are believed to be at risk of getting sick.8 Repealing the Affordable Care Act
would allow insurers to continue charging discriminatory premiums to people with health conditions—but promoters of repeal would retain this protection
against high premiums for themselves.
A complete package of health insurance benefits
Members of Congress receive a comprehensive package of health benefits that includes coverage for physician services, preventive care, hospital care, emergency care, mental health services, and prescription drugs. The Affordable Care Act requires that insurers offer American families an essential benefits package that includes these services as well.10 Repealing the Affordable Care Act would strip American families of a guarantee that insurance plans must provide a full range of necessary health care services.
Guaranteed coverage that can’t be taken away
Unlike what has happened to thousands of consumers in the individual market, when members of Congress get sick, their insurance company doesn’t suddenly revoke their coverage. The Affordable Care Act ensures that the same is true for all Americans by allowing rescissions of coverage only when there is clear and convincing evidence that an enrollee committed fraud, not when insurers simply want to avoid paying claims for enrollees who get sick. Repealing the Affordable Care Act would eliminate this vital consumer protection.
A prescription drug benefit with no coverage gap
All of the plans that are offered to members of Congress include comprehensive benefits packages that cover the prescription drug needs of members and their families throughout the whole year—without a coverage gap. Seniors and people with disabilities who are currently enrolled in the Medicare Part D prescription drug program do not benefit from the same sort of continuous drug coverage.13 The Affordable Care Act will fix this by closing the “doughnut hole” in Medicare Part D.14 Repealing the Act will take this needed help away from vulnerable Medicare beneficiaries.