GOP Health Bill would allow states to determine "prerequisites" Protections: Shots
Ryan Lennon Fines, aged two, was born with a condition called esophageal atresia that requires expensive medical treatment. Her family worried about the new GOP health statement that would make it more difficult for Ryan to get insurance in the future because of her pre-existing health condition.
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Ryan Lennon Fines, aged two years, was born with a condition called oesophageal atresia which requires expensive medical treatment. His family worried about the new GOP health statement would make it harder for Ryan to get insurance in the future because of his pre-existing medical condition.
Bram Sable-Smith / KBIA / Side effectsRyan Lennon Fines seems to be a typical 2 years old. He and his parents, Scott Fines and Brianna Lennon, cross a book of images of emergency vehicles. Ryan looks for the bike, but a picture of a plane grabs his father's eye.
"This is an air ambulance," Fines told her. "You have been on one of these".
When Ryan was born in 2014, his mouth was not connected to his stomach. This is a condition known as esophageal atresia. After three months in a hospital in St. Louis, the family flew to Boston, where Ryan underwent surgery.
The surgery worked. Ryan is active and can eat normally - he had two large pieces of fruit leather and crackers within 45 minutes where I was there. But all this time at the hospital was expensive. In the first six months of his life, Ryan's insurance plan was billed $ 750,000. The family had to pay only $ 5,000 - Ryan's maximum spending, under its insurance plan, for 2014 and 2015.
"We were lucky that we had A good plan [health insurance] provided by the employer, "says Lennon.
Now the family is worried about Ryan 's future. He will still need between $ 20,000 and $ 30,000 of medical care each year. They have insurance through the work of Fines, but the health care bill that Republicans spent in the House last week could affect Ryan's care.
The six Missouri Republicans - including Vicky Hartzler, from the neighborhood where Scott, Brianna and Ryan live - voted for the bill, which uncovers many provisions and protections from the Care Act Affordable, known as Obamacare. In a video posted on Twitter, Hartzler said passing the bill was an important first step in replacing the ACA.
"It covers pre-existing conditions," she says, "still retains the ability of young people to stay on their parents' policies and ensures that there are no lifetime ceilings ".
That is true, but the bill also gives states the power to allow insurers a number of exemptions from federal law. For example, while the GOP bill retains the provision of the ACA that people like Ryan, who have pre-existing conditions can not be denied coverage, there is a potential gap. In a last - minute amendment proposed by Representative Tom MacArthur, RN.J., a state could seek authorization to allow insurance companies to charge more to patients (depending on their health history) If their coverage lapses for more than 63 days.
This provision in the GOP bill would greatly weaken the ACA protections, said Larry Levitt, senior vice president of the Kaiser Family Foundation.
"This would guarantee access to insurance for people with pre-existing conditions in theory, but not really in practice - as they could be charged astronomically high premiums," says Levitt .
Before the Affordable Care Act was promulgated in 2010, he said it was common for people with pre-existing conditions to receive much higher premiums or to be totally refused. If a state decides to waive the protections of federal law, it could happen again.
Scott Fines and Brianna Lennon were able to retain medical expenses for their son, Ryan, in failure by employer insurance. Although Ryan's health is good now, he needs between $ 20,000 and $ 30,000 in medical care each year.
Bram Sable-Smith / KBIA / Side effects
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Scott Fines and Brianna Lennon were able to retain medical expenses for their son, Ryan, in failure by employer insurance. Although Ryan's health is good now, he needs between $ 20,000 and $ 30,000 in medical care each year.
Bram Sable-Smith / KBIA / Side effects
The amendment would require states asking for a waiver also have to help people who have high health care costs. High-risk pools are the most frequently cited type of program to do so, but they were often underfunded and costly to consumers and governments.
Governor of Missouri, Eric Greitens, Republican, supported the GOP health plan in March. His office did not answer NPR 's questions as to whether he supports the current version of this bill or whether he wants Missouri to seek permission to withdraw from Certain provisions. Levitt says it would probably be Conservative states like Missouri and the other 18 states that have not expanded Medicaid, which might try to pull out.
These states, Levitt said, "have made the decision not to agree on the Affordable Care Act, and I think these states are facing a similar decision here."
Fines and Lennon say they face tough decisions if this bill becomes law.
"We had to move to a state that did not give up protecting the community or out of the country if we could," says Fines. "I would not risk my son's health over the political whims of Jefferson City."
But before any decision made in the state capital of Missouri, Bill GOP is in the hands of the US Senate, where it could change before becoming federal law.
This story is part of NPR's partnership with KBIA, Side Effects Public Media and Kaiser Health News.
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