美国国家公共电台 NPR Q&A: What Does The Senate Health Bill Mean For Me?

ROBERT SIEGEL, HOST:

We've received a lot of questions from listeners about what the Republican proposals could mean for them and their families. And NPR health policy correspondent Alison Kodjak has been sorting through them with our producers, and she's here to answer a few of them. Hi, Alison.

ALISON KODJAK, BYLINE 1: Hi, Robert.

ARI SHAPIRO, HOST:

The first listener we're going to hear from has a very common situation. Here she is.

DENISE ESTRADA: My name is Denise Estrada, and I live in Los Angeles, Calif. My husband, Rick (ph), and I are both self-employed, and we're both in our early 50s with one daughter in college. And we get our health care through the California exchange. We use Kaiser. Our family premium 2 now costs us about $1,100 a month, so we're looking at about $16,000 a year just for our premiums 3 not including our deductible, and we do not receive a subsidy 4.

So here's my concern. Based on what I've read and what I've watched on television, it appears that our age group - we're not retired 5 yet, but we're over the age of 50. We stand to see the biggest increase in our premium cost. So there's a lot of stress about that because it's a big unknown. Will our premiums rise astronomically 6 due to our ages?

KODJAK: You know, that's a valid 7 concern. This bill does allow insurers to charge older people more than they do now, and the Affordable 8 Care Act has limits on that. It allows insurers to charge older people three times more than it charges the youngest. This bill allows that to go up to five times more. So the hope is that it will lower premiums for younger people. But at the same time, the Congressional Budget Office says it's going to raise premiums for older people. And I actually looked up Mrs. Estrada's specific situation. The Kaiser Family Foundation has this little widget, and a 60-year-old in Los Angeles County who doesn't qualify for subsidies 9 is likely to see her premium increase $2,600 a year.

SIEGEL: Now, we also heard from listeners who are anxious about the potential introduction or perhaps reintroduction of lifetime maximums for insurance coverage 10.

AMY LOWE: My name is Amy Lowe, and I'm from Dayton, Ohio. We get our insurance through my husband's employer. My daughter is 16 years old, and she has Crohn's disease, which is an autoimmune condition that affects her small and large intestine 11. She requires infusions 13 of a drug called Remicade every six weeks, and each infusion 12 costs $20,000. So I would like to know if lifetime maximums are in fact being considered. And if so, what happens to people like my daughter?

KODJAK: And that's a really good question. It's a complicated answer. The Affordable Care Act does ban lifetime limits on benefits. And those protections are at risk because states under this bill are allowed to ask for waivers from those consumer protections, those regulations that are in Obamacare that define what insurance companies have to cover. And because of some loopholes in the law, even if just one state gets a waiver from those, all large employers can opt 14 into those rules.

So if a state gets a waiver from lifetime limits, there could be a lot of insurance policies, even those you get through employer, that might have a $1 million, $2 million, $5 million limit. And it's not really a theoretical question because before the Affordable Care Act, almost 60 percent of employer plans had a lifetime limit on it.

SHAPIRO: And of course a lot of people who use Medicaid are wondering what the future might hold for them. Let's listen to this.

EMILY KANE: My name is Emily Kane, and I live in Pittsburgh, Pa. My son's 2-and-a-half years old, and he qualified 15 for Medicaid through a clause that allows children who are chronically 16 ill to receive Medicaid support. He has an endocrine disorder 17 called adrenal insufficiency. In order to get him back to health and stability, he's needed the assistance of a feeding tube, which is now surgically 18 placed. So I'd like to know how the GOP's health care bill will affect our family's financial future and the future of my son's medical care.

KODJAK: That's a tough one. Obviously it's impossible to know exactly how this bill will play out over that much time. The Medicaid program that helped her son specifically is a state program. A lot of Medicaid programs can be implemented 20 by the states. And so this is a Pennsylvania-specific program. The law - the proposed bill in the Senate would actually give states more power to regulate and implement 19 their Medicaid program. So there's no reason to think this specific program's at risk, but Medicaid's also facing enormous cuts. The CBO says that in 10 years, there's going to be 26 percent less money for Medicaid. So that's where the concern is - whether the benefits will be there.

SHAPIRO: NPR's Alison Kodjak answering your questions about the health care proposal. Thanks very much.

KODJAK: Thanks, Ari.

SIEGEL: And if you have questions about the Republican health care proposals, email them to us at nprcrowdsource@npr.org, and put health care in the subject line. And tomorrow morning, we'll hear what the Senate bill would mean for veterans. Most of them receive health care through Medicaid or the exchanges, not through the VA. Listen for that and more as you begin your day with MORNING EDITION.