National Nurses United

right. Cruz's response: "access to care" is the right. To which Bernie aptly responded, "access" is not care if you can't afford it. The sad irony of the ACA is that it was a convoluted attempt to straddle both worlds: public mandates, including the expansion of Medicaid, curbs on many insurance abuses, and a number of required benefits for ACA plans, with multiple handouts to entrench and enrich healthcare corporations, from insurers to hospitals to drug companies. The result: The critics are right—the ACA out-of-pocket costs are out of control and the insurance networks are limited. But that's because the ACA was modeled on a Republi- can-Mitt Romney plan in Massachusetts with mechanisms set in place to protect the healthcare industry. And all the replacement schemes envi- sioned by Cruz and his cohorts would make it even worse. Their rhetoric over costs under the ACA are a convenient stalking horse for "replacement" plans that would not guarantee lower costs, but even greater license for corpo- rations to charge all that they can get. They would shut even more people out, letting them die if they cannot afford the inflat- ed costs or become trapped in a byzantine scheme of health savings accounts, high-risk pools, or bare bones insurance plans, all premised on how much you can pay. Only one replacement plan would actual- ly fix the real holes in the ACA, and the far greater pre-ACA disaster that saw the Unit- ed States plummet to 37th in world rank- ings on healthcare access, cost, and quality early in this century. That is, of course, as Sanders emphasized in his campaign and in the debate, an improved Medicare for all. RoseAnn DeMoro is executive director of National Nurses United. (1) Pre-ACA and ACA Number of Uninured is from the US Census Bureau, appropriate years (2) David U. Himmelstein, MD, Deborah Thorne, PhD, Elizabeth Warren, JD, and Steffie Woolhandler, MD, MPH. Medical Bankruptcy in the United States, 2007: Results of a National Study - The American Journal of Medicine, Vol 122, No 8, August 2009. http://www.amjmed.com/article/S0002-9343(09)00404-5/fulltext (3) David U. Himmelstein, MD, Deborah Thorne, PhD, Steffie Woolhandler, MD, MPH. Medical Bankruptcy in Massachusetts: Has Health Reform Made a Difference? - The American Journal of Medicine. March 2011Volume 124, Issue 3, Pages 224– 228. http://www.amjmed.com/article/S0002-9343(10)00991-5/fulltext (4) 2016 Employer Health Benefits Survey, Sep 14, 2016. http://kff.org/health-costs/report/2016-employer-health-benefits- survey/ (5) Commonwealth Fund Biennial Health Insurance Survey, 2016. http://www.commonwealthfund.org/publications/ issue-briefs/2017/feb/how-the-aca-has-improved-ability-to-buy-insurance (6) Pre-Existing Conditions, U.S. Department of Health & Human Services. https://www.hhs.gov/healthcare/ about-the-law/pre-existing-conditions/index.html (7) Republicans say they'll protect you if you have a pre-existing condition. Don't believe it. https://www.washingtonpost.com/blogs/plum-line/wp/2017/01/13/republicans-say-theyll-protect-you-if-you-have-a- pre-existing-condition-dont-believe-it/?utm_term=.bf50577b9a7c (8) Archived webpage: State Coverage Initiatives - Robert Wood Johnson Foundation. http://www.statecoverage.org/ coverage_strategies/dependent_coverage.html (9) Young Adult Coverage, U.S. Department of Health & Human Services. https://www.hhs.gov/healthcare/ about-the-law/young-adult-coverage/index.html# (10) Can my health insurance company cancel my policy for any reason? Feb 1, 2001. http://law.freeadvice.com/ insurance_law/health_insurance/healt_insurance_cancel_policy.htm (11) Cancellation & Appeals, U.S. Department of Health & Human Services. https://www.hhs.gov/healthcare/ about-the-law/cancellations-and-appeals/index.html (12) Health Insurance Appeals and Exception Requests. http://www.nationalmssociety.org/Resources-Support/ Insurance-and-Financial-Information/Health-Insurance/Appeals (13) Appealing Health Plan Decisions, U.S. Department of Health & Human Services. https://www.hhs.gov/healthcare/ about-the-law/cancellations-and-appeals/appealing-health-plan-decisions/index.html (14) Essential Services include: Emergency Services, Hospitalizations, Laboratory Services, Maternity Care, Mealth Health and Substance Abuse Treatment, Outpatient, or Ambulatory Care, Pediatric Care, Prescription Drugs, Preventive Care, Rehabilitative and rehabilitative Services, and Vision and Dental for Children (15) Preventive Care, U.S. Department of Health & Human Services. https://www.hhs.gov/healthcare/about-the-law/ preventive-care/index.html (16) The Health Care Law's 10 Essential Benefits. http://www.aarp.org/health/health-insurance/info-08-2013/ affordable-care-act-health-benefits.html (17) The Health Care Law's 10 Essential Benefits. http://www.aarp.org/health/health-insurance/info-08-2013/ affordable-care-act-health-benefits.html (18) How Obamacare improved mental health coverage. By Louise Norris, February 16, 2016. https://www.healthinsurance.org/blog/2016/02/16/how-obamacare-improved-mental-health-coverage/ (19) Private Insurance Coverage of Contraception. By Laurie Sobel, Adara Beamesderfer, and Alina Salganicoff; 12/7/2016. http://kff.org/womens-health-policy/issue-brief/private-insurance-coverage-of-contraception/ (20)Birth control benefits. https://www.healthcare.gov/coverage/birth-control-benefits/ (21) How Obamacare improved mental health coverage. By Louise Norris, February 16, 2016. https://www.healthinsurance.org/blog/2016/02/16/how-obamacare-improved-mental-health-coverage/ Pre-ACA ACA Single Payer Republican Plan Number of insured (1) 256.2 million (2010) 289.9 million (2015) Whole Population Likely Decrease to Pre-ACA Levels Percent Insured (1) 83.70% 90.90% 100% Likely Decrease to Pre-ACA Levels Number of uninsured (1) 49.9 million (2010) 28.9 million (2015) 0 Likely Increase to Pre-ACA Levels Percent Uninsured (1) 16.30% 9.10% 0 Likely Increase to Pre-ACA Levels Lifetime Limits on Health Insurance Coverage Established by Health Insurance Companies No Lifetime Limit on Health Insurance Coverage No Lifetime Limit Established by Health Insurance Companies Choice of Providers and Hospitals Limited Networks Often more Restrictive Networks Free choice for doctor and hospital Limited Networks Benefit levels Restricted by insurance companies and ability to pay Restricted by insurance companies and ability to pay, with minimum required benefits from ACA Coverage for all medically necessary services Restricted by insurance companies and ability to pay Medical Bankruptcy 62.1% of all bankruptcies (2) 52.9% of all bankruptcies (3) [Massachusetts under Romneycare] No Medical bankruptcies Likely Increase to Pre-ACA Levels Average annual deductable costs for employer provided health plans for single coverage (4) $917 (2010) $1,478 (2016) $0 Likely to Increase Average Annual Worker Contribution to Premiums for Family Coverage (4) $3, 997 (2010) $5,227 (2016) $0 Likely to Increase Number of adults reporting trouble paying medical bills (5) 73 million (2010) 70 million (2016) 0 Likely to Increase Number of adults ages 19-64 who reported not getting needed care because of cost (5) 75 million (2010) 63 million (2016) 0 Likely to Increase Pre-existing Conditions Health insurance companies can refuse to cover you or charge you more if they determine you have a "pre-existing condition" Health insurance companies can't refuse to cover you or charge you more because you have a "pre-existing condition" (6) All preventative and medically necessary services will be covered Individual would have to maintain "continuous coverage" to be guaranteed insurance. (7) Young adult dependent coverage Unless they are students, dependents typically lose eligibility on their parents' or caregivers' insurance on their 19th birthday (8) Child dependents can stay on parents health insurance policy until they turn 26 years old (9) Everyone is covered Dependent coverage likely to be reduced to age 19 Policy Cancellation Health care insurance companies could cancel someone's policy if they found the insured individual had failed to disclose something from their medical history or their covered dependents (10) Insurance Companies can no longer cancel your coverage just because of an honest mistake on your application. Policy cancellations can also be appealed to a third party. (11) Everyone is always covered Will likely increase insurance companies' ability to cancel plans and hike rates w/o recourse Appealing insurance company's refusal to pay for care or termination of health coverage The right to appeal was not available in many states, and depended on the type of policy (12) You have the right to appeal a health insurance company's decision to deny payment for a claim or to terminate your health coverage to an independent third party (13) All preventative and medically neces- sary services will be covered No guaranteed right to appeal Coverage of "Essential Services" (14) Depended on Health Insurance Policy Covered Covered Will depend on health insurance policy Preventive Care Usually paid out of pocket If insured, available at no cost (15) All preventative and medically neces- sary services will be covered Will be left to insurance companies' discretion Prescription Drugs Some plans offer drug coverage, but only as an option at extra cost All individual and small-group plans will cover at least one drug in every category and class in the U.S. Pharmacopeia, the official publication of approved medications in this country. Drug costs will also be counted toward out-of-pocket caps on medical expenses. (16) All preventative and medically necessary services will be covered Will depend on health insurance policy Emergency Care Some plans offer emergency care coverage, but often with hiked up charges Emergency room visits do not require preauthorization, and you cannot be charged extra for an out-of-network visit (17) All preventative and medically necessary services will be covered Will depend on health insurance policy Mental Health Services Most plans don't cover mental or behavioral health services All individual and small-group plans are required to cover mental health and addiction treatment (18) All preventative and medically necessary services will be covered Will depend on health insurance policy Birth control benefits Insurers and employers could choose whether or not to provide coverage for contraception (19) Plans must cover contraceptive methods and counseling for all women, as prescribed by a health care provider, at no cost (20) All preventative and medically necessary services will be covered Will depend on health insurance policy Maternity and Newborn Care Many plans didn't cover Maternity and Newborn Care, in fact two-thirds of individual plans excluded this type of coverage Prenatal care must be provided at no extra cost, and insurers must cover childbirth as well as the newborn infant's care (21) All preventative and medically necessary services will be covered Will depend on health insurance policy Pediatric Care Few health plans covered children's dental or vision services Health plans must cover children's dental or vision services, including children under age 19 getting their teeth cleaned twice a year, receive X-rays, fillings, and medically necessary orthodontia. In addition, children under age 19 will be entitled to an eye exam and one pair of glasses or set of contact lenses a year (22) All preventative and medically necessary services will be covered Will depend on health insurance policy J A N U A R Y | F E B R U A R Y 2 0 1 7 W W W . N A T I O N A L N U R S E S U N I T E D . O R G N A T I O N A L N U R S E 11

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