The American Health Care Act: What You Need to Know

医疗保健方面的事情进展迅速。上周，众议院投票通过了《美国医疗法案》，该法案改变了《平价医疗法案》(也被称为“奥巴马医改”)的几个关键特征。该法案已移送至参议院，在那里可以按原样进行投票，也可以进行修改，然后送回众议院进一步审议。

We want you to know that the Arthritis Foundation and our army of volunteer Advocates are on the job, working hard to ensure that YOU have affordable access to the care you need.

如果你想更好地了解这个法案，它会如何改变你的覆盖范围、费用和获得医疗保健的途径，以及我们正在采取的行动，请继续阅读。

Let’s start with some background:

• This bill is not a full repeal of the Affordable Care Act (ACA). It replaces and amends certain provisions in the ACA. All other aspects of the ACA would remain in place.
• The bill addresses health care issues at the federal level, but gives states the option of requesting waivers, exempting them from certain federal requirements. The waivers add to the control states already have over aspects of health care, insurance and Medicaid.
• Quick take: This bill would have a significant impact on older people and those who are chronically ill.

Following are some common questions raised by the proposed bill.

我能得到保险，因为我有______[填写关节炎类型]，一个既存状况?
The current requirement to cover people with pre-existing conditions has not changed. So yes, you will be able to get a policy. But whether or not you will be able to get an adequate, affordable policy is not clear. Important protections are missing.

The plan would bring back state high-risk insurance pools, which, before the ACA, were the only way people with chronic illnesses could get insurance. The plans were very expensive and unaffordable for many people, and came with limited benefits and a coverage delay of six to 12 months after purchase.

Plans in the new state high-risk pools are likely to be expensive, too. Right now, people with pre-existing conditions pay no more than a healthy person does for the same plan. If this bill passes, states that receive federal waivers can price plans based on health status and offer fewer or weaker benefits. This may mean you end up paying more for less.

With minimal federal support, states may not have the funds to sustain high-risk pools, which inevitably run at a deficit, because of the plan members’ heavy usage of the medical system.

I have insurance now, but it is definitely a strain on my budget. Would the new plan give me a break?
这取决于你的年龄和收入(以及你的健康状况，见上文)。目前，对于同样的保单，保险公司向老年人收取的保费比向年轻人收取的保费高多少是有限制的。拟议中的计划将放宽这一限制，允许保险公司向老年人收取的保费最多是向年轻人收取的保费的五倍，而不是目前的三倍。

Older people would also lose some of the financial relief they now get through tax credits. Today, premium tax credits are based on a percentage of income. Under this bill, there will be a flat-rate tax credit, based on age rather than income. And the tax credit will be phased out for those with an income of over $75,000 ($150,000 for those who file jointly). So your health status, age and income could all affect the cost of your coverage. And that’s before any changes in cost sharing, such as deductibles, copays, coinsurance and annual and lifetime limits, are factored in.

Can I count on the same basic benefits I get now?
这将取决于你所在州的决定。拟议的计划并没有取消覆盖10个基本健康福利类别的要求(药物覆盖、门诊护理、实验室检测、住院、紧急服务、孕产妇和新生儿护理、精神健康和药物滥用治疗、物理和职业治疗和设备)。但有一个问题。各州可以获得联邦豁免，允许本州的保险公司出售排除一些基本健康福利的保险计划。

Will I still be protected by the cap on annual out-of-pocket costs and the ban on lifetime limits? The medical care and drugs I need are pretty expensive.
The bill leaves those protections in place, but in reality your state will determine whether you will get the full protection you have now. Those protections only apply to spending on care covered by your plan’sessential health benefits. So if your state gets an essential health benefits waiver, what you spend for those services will not be protected by the annual cap or lifetime limit. For example, if your plan doesn’t have prescription drug coverage, your spending on drugs will not be capped or limited.

Am I at risk of losing Medicaid coverage under the proposed plan?
That depends on the state you live in. Overall, Medicaid is expected to tighten who is covered, so your coverage may be at risk. The bill would essentially create a rollback of the Medicaid expansion that occurred under the Affordable Care Act. It would significantly decrease funding to states for Medicaid, which will lead to coverage loss for many.

My daughter who is 23 has juvenile idiopathic arthritis, and I need to keep her covered under my plan. Will I be able to do that?

Yes. The bill leaves in place that option, which was implemented with the ACA.

总之，这项法案将对美国老年人和那些已有疾病的人产生不成比例的负面影响。虽然该法案保留了一些保护措施，比如允许孩子在26岁之前继续享受父母的保险，但它为各州大幅改变保险覆盖范围和福利提供了可能。新的税收抵免结构，加上允许保险公司向老年人收取更多费用的新的年龄评级结构，可能会提高美国老年人的成本分摊。

What is the Arthritis Foundation doing about this?

• We plan to engage our staff and Advocates as this bill moves on to the Senate for consideration. Our goal is to ensure that senators know how these policies would impact people with arthritis, and to offer constructive policy proposals that will help make health care truly patient-centered.
• We have outlined some policy proposals to Congress that will form the basis of our advocacy. We will work with our army of volunteers to collect patient stories, educate them about new developments and call them to action as this bill moves through Congress.

We welcome your feedback and questions, and want you to know you can always use the Arthritis Foundation as a resource and sounding board. We are here for you.