By now we are all aware that if ACA is repealed, then millions of Americans will lose subsidized health care coverage that they otherwise could not afford. And if ACA approved Medicaid expansion programs are halted, this will result in loss of state-implemented health care coverage for low income working poor.

As ACA repeal looms closer to reality, we read these facts in our daily headlines.

But beyond the 20 million or more Americans that will be thrust off their insurance policies, and back to the medical bankruptcy crisis that existed before ACA passed, there are also lesser known pieces that many don’t know about.

The first, and probably the most crucial piece of ACA that Congress has been quietly slaying is the Co-Op option. If you live in a Republican state, then you probably don’t know much about these, as Co-Ops strike fear in the hearts of for-profit insurers. Co-Ops are locally-controlled, member-owned, non-profit health delivery systems, and the salaries of its CEO’s are under the control of the members who pay the premiums. The majority of the board of directors must also be members:  customers of the same policies they design for everyone else.

During the past 6 years of Republican control in congress, the Co-Op program has been under fire and all the ACA promised funding has been slashed repeatedly by the conservatives.  In fact, Indiana’s own Co-Op, “Remedy Indiana”, was a victim of the Fiscal Cliff negotiations – all future HHS funding was cut before “Remedy Indiana’s” application was ever approved (along with 20+ other Co-Ops).

The good news is that before the Fiscal Cliff showdown that destroyed any future Co-Ops, 24 Co-Ops had already been funded and made it through!

The Co-Op program is not dead. A change to Democrat rule in congress could have revived the funding and brought the program back on its feet.  But now that conservatives and pro-insurance lobby are back in the saddle, we may lose the closest thing we have ever had to a public health care option for the general population.

Read more about how congress took away our right to have this “choice” when we chose a plan in the ACA state Exchanges.

To read more about “Remedy Indiana”:

Federal External Review – Fighting your insurance company

Another important piece of legislation that we will lose if ACA is repealed, is the HHS-Administered Federal External Review. Prior to ACA passage, President Obama had heard from many constituents about the problem with insurance companies rejected and denying claims.  People whose doctors were recommending procedures would sometimes find the insurance company was refusing to cover.

This appeal process is not controlled by the insurance industry. It is overseen by a panel of experts at the Federal level – including a majority of medical professionals. This requirement is written in the ACA law.

This federal appeals process has always been fiercely opposed by the insurance lobby and politicians who are closely connected to the trillion-dollar insurance industry. At one point, some of these politicians tried to scare the public by erroneously labelling this much-needed consumer benefit a “Death Panel”.

Pre-existing conditions: Beware of the “High Risk Pools”

But perhaps the most important piece of the ACA pertains to patients who have existing health conditions or perhaps are simply experiencing age-related ailments. Covering the pre-existing condition patient is extremely expensive and insurance companies don’t want to be forced to do this. There is no way around the fact that adding sick people to the general population coverage pool will raise premiums for all.  It is very expensive to cover our sick and aging population, which is why Medicare was created half a century ago for seniors over 65.

But medical costs are higher today that ever before. Most treatments involve high levels of technology and costly blood testing, with machines and laboratory cultures that are far more expensive than they were in the 1960’s. Salaries for surgeons and specialists are triple and quadruple what they were in the 1960’s. One example: the average salary for an anesthesiologist in the USA today is more than $320,000 per year; a fraction of their salary years ago.

The pre-existing condition clause will go away when the ACA is repealed.

House republicans, led by Paul Ryan, are comforting our fears by telling us that they have a “plan” to make sure the sick and aged don’t lose their policies.  But you need to listen very careful to their proposals:  They are not promising access to the same policies as everyone else — they are suggesting that all the sick be removed from the general pool and placed together in a “high risk pool” in each state.

For all of you who understand how insurance works, you know that there would be no way for an insurance company to support such a hefty high risk condition with reasonable rates and deductibles. The premiums would have to be very high with the payout being very limited.  High Risk pools offered in the past generally will not pay anything until a catastrophic medical bill has been incurred. And the monthly premium is usually very expensive too.

House Speaker Paul Ryan knows the premiums on these plans will be astronomical. And that is why he has already mentioned that these will be offered with a premium subsidy for low income users.  What he doesn’t say is how a lower- or mid-middle class person would be able to afford such a policy that runs $1,900 or more per month and pays out only when a catastrophe happens.

We need to be diligent and demand that Americans will get quality coverage for everyone, not just a plan that will lower the premiums for the healthy and cause us to return to a time of financial crisis among the aging and pre-existing condition population who are purged from their insurance plans.

$40,000 in advertising has already been spent to push a vague version of the Ryan plan that leaves out some very pertinent details, such as the high risk pools. Read more about Ryan’s proposal here:

Watch video and listen carefully to the words used as they describe their replacement plan:

“We’re working on this as fast as possible. Definitely within these first 100 days of Trump’s presidency.” House Speaker Paul Ryan