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Will My High Premiums Go Down? More Q&A About The GOP Health Plan

Gary Waters
Ikon Images/Getty Images

We've received hundreds of responses to our callout for questions about the Senate Republicans' proposed overhaul of the Affordable Care Act. Earlier this week, we answered questions about continued coverage for serious health conditions and insurance premiums for older adults. Today, we begin with a question from a young adult who says he's excited about the potential repeal of Obamacare.

Q: I'm a 29-year-old who lives in Minneapolis. I purchased my insurance through the exchange for 2 1/2 years. What started to concern me were the increasing premiums that started to feel out of proportion with my actual true costs of health care.

I don't qualify for a subsidy, and I went from paying maybe $120 a month to paying somewhere in the neighborhood of $300 to $400 a month for health coverage. And I was seeing the doctor once a year for a checkup, and other than that, would not step inside a doctor's office.

-- Jordan Myers, Minneapolis, Minn.

A: Jordan is right to be optimistic. Under the Senate's draft bill, Jordan's costs may go down.

The Affordable Care Act says an insurer can only charge older people three times what they charge young people for comparable coverage. The Senate plan loosens those restrictions, allowing insurance companies to charge people over the age of 50 five times what they charge people in their 20s.

The hope is that prices for those so-called "young invincibles" will go down enough that more of them will decide it's worth the money to buy insurance. And the extended hope is that will cut prices for everybody, because more young people like Jordan, who don't use much health care, will be paying into the system.

It's important to note that the vast majority of people who buy insurance on the Affordable Care Act exchanges do get subsidies, so they aren't paying premiums as high as Jordan is.

Q: I'm the mother of two teenage boys, ages 13 and 14. My children may have a disease called left hypertrophic cardiomyopothy.

It's a disease that killed my maternal grandfather at the age of 52. It killed my mother at 52, and my brother had a heart transplant at the age of 51 and 9 months.

I've been asked by our cardiologist to have them genetically tested to see if we can indicate the disease. I'm refusing for the only reason that if they are positive for this disease, they will then have a pre-existing condition that may exclude them from health care later on.

It seems like a ludicrous decision that I'm having to make, but it's one I have to take seriously.

-- Amy Meyer, Corona, Calif.

This is such a difficult situation because of the frightening medical issues and the uncertainty over how the health care system may change.

One of the major aims of the Affordable Care Act — really, a core reason that it exists at all — is that insurance companies used to routinely refuse coverage to people who had been diagnosed with a medical condition.

And often, if they did offer coverage, it would include exceptions for pre-existing medical conditions.

The Senate health bill keeps those protections in the federal law, requiring insurance companies to offer policies to those with pre-existing medical conditions.

However, it then provides a giant loophole for states that want to loosen regulations on insurers. States can seek waivers for many of the Affordable Care Act consumer protections, including the so-called essential health benefits, or the list of things an insurance company has to pay for to be considered legal under Obamacare. The list includes prescription drug coverage, mental health care and maternity care.

So with such a waiver, an insurance company would have to write a policy for someone with a pre-existing condition, but those policies would not necessarily pay the costs of treatment for some conditions. For example, a policy could cover doctor and hospital visits, but if it doesn't pay for prescription drugs, it may not help a cancer patient who needs expensive medicine.

Q: There's an important part of the health care bill that usually gets left out of the reporting on this issue: the tax cuts. How much does one have to make to benefit from the tax cut aspect of this bill?

-- Pam Tellew, Albany, Calif.

A: There are about a dozen taxes that are part of the Affordable Care Act, and the Senate bill proposes repealing all of them. Most are taxes on corporations such as insurance companies, medical device companies, and tanning salons. Republicans argue that those taxes raise costs for all health care consumers, and therefore everyone will benefit if they are repealed.

There are two specific taxes on individuals. The first is a surtax of 0.9 percent on the income of single people who earn more than $200,000, or married couples who earn more than $250,000.

In addition, there's an additional 3.8 percent tax on investment income for people in those same income ranges.

Copyright 2021 NPR. To see more, visit https://www.npr.org.

Alison Fitzgerald Kodjak is a health policy correspondent on NPR's Science Desk.

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