The Greenville News
March 1, 2017
By Liv Osby
Health insurance is a complicated topic to untangle for most people and coverage under the Affordable Care Act is no exception.
But throw a bunch of other plans into the mix and things can really get confusing.
So as Congress considers repealing and replacing the ACA, also known as Obamacare, the Kaiser Family Foundation, a nonprofit, nonpartisan health care research group, developed a tool that lets consumers compare the ACA with four Republican plans proposed so far.
Those plans are Rep. Tom Price’s 2015 Empowering Patients First Act, House Speaker Paul Ryan’s 2016 A Better Way: Our Vision for a More Confident America, Sen. Bill Cassidy’s 2017 Patient Freedom Act, and Sen. Rand Paul’s 2017 Obamacare Replacement Act.
The tool shows which plans have bans on pre-existing condition exclusions and annual and life-time caps, for example. Or those that allow children to remain on their parents’ plans until age 26. Or set standards for minimum coverage.
It also compares provisions for tax credits, health savings accounts, high-risk pools, selling insurance across state lines, and association health plans. It shows how each plan would affect Medicare and Medicaid, too.
Ryan’s bill, for example, would raise the Medicare eligibility age to 67 and turn it into a voucher system that would give beneficiaries a set amount of money to purchase insurance on the open market, though it would include traditional Medicare as an option.
The tool is a good way for people to bone up on the proposals and to compare them to each other and to the ACA, said David J. Fleming, associate professor in the Department of Politics & International Affairs at Furman University.
“There’s a lot of misinformation and lack of information about the Affordable Care Act,” he said. “And given the new administration and the number of proposals in Congress to change the (ACA), some of which are included in the (Kaiser) website, now is a really good time to … get informed.”
The tool allows a side-by-side comparison of up to three plans at a time.
Sara Collins, vice president for Health Care Coverage and Access at The Commonwealth Fund, said that while the plans aren’t very detailed yet, consumers need to look at the fine print when comparing them.
Particularly important are provisions dealing with premium tax credits, the replacement of Medicaid with block grants, and the expansion of health savings accounts, she said, because they have significant cost implications for consumers, especially low-income people, who make up the largest share of the uninsured.
“A huge problem that people on both sides of the aisle face when it comes to policy,” said Fleming, “is that often the public isn’t generally very well-informed on these issues, versus having an opinion.”
One challenge of the tool is that some the proposals haven’t been examined by the Congressional Budget Office for estimates of plan costs and how they would affect the number of uninsured people in the country, he said.
And that information could have an impact on the politics surrounding the replacements, he said, adding that Republicans haven’t yet coalesced around any plan.
“And one of the challenges of the repeal and replace idea is that many policies are popular and people are receiving benefits,” he added. “Taking them away can be politically difficult.”
In addition, he said the Trump administration hasn’t come out with its plan yet.
Sue Berkowitz, director of the South Carolina Appleseed Legal Justice Center, said the tool may be a bit technical for some people, and that the plans need more work before they could be an option for replacement.
“For me,” she said, “it is … still worth it for people to look at in an effort to understand the proposals.”
Compare and contrast
Frank Knapp, CEO of the South Carolina Small Business Chamber of Commerce, said that while the tool is useful, it would be helpful if it included the number of people who would gain or lose insurance for each plan.
“It’s a nice way to compare things,” he said. “It’s a good tool for the media, members of Congress, or legislators in states, and people interested in this whole issue of repeal and replace who are willing to do a deeper dive.”
But Christopher Witko, associate professor of political science at the University of South Carolina, said the tool will probably be used more by policy wonks than average citizens, many of whom will simply rely on their political leanings.
“It’s pretty sweet. I like it,” he said. “Certain people really into politics and policy will really check it out. But I don’t think people will spend a lot of time digging into the weeds.”
Columbia health care consultant Lynn Bailey said the tool will help her explain the plans to others.
“I have copies of all of these various bills, but this is created in a very nice electronic spread sheet,” she said. “It’s a true public service.”
To access the Kaiser Tool, go to http://kaiserf.am/2kRjoT4.