Mixed reaction to health care bill; trucking impact uncertain

Doctors, hospitals and insurers criticize Republican plan; business groups applaud bill for lowering costs

Mirroring the view throughout the nation, the trucking industry is mixed on its initial thoughts regarding the U.S. House of Representatives passing an Affordable Care Act (Obamacare) replacement bill on Thursday.

While the American Health Care Act (AHCA) targets the individual market, it could cause a ripple effect on employer-based plans and it almost certainly will affect individual truck drivers.

The bill has been sent to the U.S. Senate, but news reports indicate it has little chance of being passed as is. How the two houses will reconcile the differences remains to be seen. At this point, much like President Donald Trump’s tax reform plan announcement, the House bill seems more like a starting point than an end point.

The American Medical Association was one of several medical groups to blast the bill.

“The bill passed by the House today will result in millions of Americans losing access to quality, affordable health insurance and those with pre-existing health conditions face the possibility of going back to the time when insurers could charge them premiums that made access to coverage out of the question,” Dr. Andrew W. Gurman, president of the AMA, said in a statement. “Action is needed, however, to improve the current health care insurance system.”

The bill has also been criticized by hospitals and insurance companies.

“The American Health Care Act needs important improvements to better protect low- and moderate-income families who rely on Medicaid or buy their own coverage,” Marilyn B. Tavenner, chief executive of America’s Health Insurance Plans, the industry’s trade group, said in a statement.

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Conversely, the U.S. Chamber of Commerce had a different reaction to the bill.

“We congratulate the U.S. House of Representatives for passing the ‘American Health Care Act’ and taking an important step forward from an unsustainable health care system that is saddling Americans with higher costs and uncertain coverage options,” said Chamber President & CEO Thomas J. Donohue, in a statement. “This bill contains important reforms that will lower costs and pull back on job killing tax hikes that have been stifling economic growth across the country. We look forward to working with the U.S. Senate and President Trump to move this important legislation forward.”

While there has been no official statement yet, in a March meeting between Trump and trucking leaders, the American Trucking Associations was generally in support of Obamacare repeal and replace efforts.

“The Affordable Care Act is just plain unaffordable. Replacing this law will help trucking employees, their families and our customers by lowering insurance costs, decrease mandates, liabilities and administrative burdens, and provide access to quality care and patient choice,” said Chris Spear, ATA president & CEO.   

“The 7.3 million people who work in the trucking industry – of which 3.5 million are professional truck drivers – have a common thread – to be safe and dependable and that requires a healthy professional behind the wheel,” added Kevin Burch, president of Jet Express and ATA chairman.

What is actually in the bill and how would it affect trucking? The bill includes many provisions that are popular with Conservatives, including an $8 billion fund to be doled out to states over five years to help people with pre-existing conditions pay for insurance. Many health experts, though, believe that fund needs to be at least $15 billion per year.

The bill also provides $138 billion over 10 years for high-risk pools for those with pre-existing health conditions who can’t get insurance in the individual market, but an analysis by consulting firm Avalere Health indicates that the amount would not cover even current Obamacare enrollees who meet the requirements.

For truck drivers, the pre-existing conditions provisions could be crucial. Under the bill, insurers could not kick off or increase premiums for those with pre-existing conditions who maintain their insurance. However, if there is a 63-day gap in insurance coverage, insurers could charge a 30% premium on the person’s next policy and also charge higher premiums.

Kaiser Family Foundation State Health Reform director Jennifer Tolbert told CBS News that before Obamacare, those with pre-existing conditions paid as much as 1.5 times an average premium.

The Foundation noted that prior to Obamacare, many insurance policies considered cancer, diabetes, sleep apnea, severe obesity, heart disease, pregnancy and many other conditions pre-existing conditions and therefore charged significantly higher premiums or denied those with them coverage.

The National Survey of U.S. Long-Haul Truck Driver Health and Injury in 2014 found that 69% of truck drivers were obese and 88% said had at least one risk factor — high-blood pressure, smoking, obesity, etc. — for chronic disease. For drivers who suffer from one of these conditions, moving to another job may become impossible for fear of losing their insurance.

President James Hoffa spoke for many drivers in his criticism of the legislation.

“The American Health Care Act is a flawed piece of legislation that should never be made into law,” said Teamsters General President Jim Hoffa. “It not only includes this destructive Cadillac Tax that targets working families, but it also allows insurance companies to discriminate against people with pre-existing conditions and charge older Americans up to five times higher premiums than younger plan holders,” he said. “Instead of finding new ways to enrich health care providers, Congress should be working to ensure that this country provides affordable health care coverage for every American regardless of their pre-existing conditions. The AHCA will lead to only one result - higher costs for lower quality care for fewer Americans.”

Republicans have maintained that the AHCA continues protections for those with pre-existing conditions, but there are caveats. Under Obamacare, insurers are prohibited from charging sicker individuals more than healthier individuals. The AHCA eliminates that as part of a state waiver process.

According to NPR, states could apply for waivers so that insurers could:

  1. Charge older people more than five times what they charge young people for the same policy;
  2. Eliminate required coverage, called essential health benefits, including maternity care, mental health and prescription drugs, that were required under the Affordable Care Act; and
  3. Charge more for or deny coverage to people who have pre-existing health conditions, such as cancer, diabetes or arthritis.

The bill would also no longer require Americans to buy health insurance and eliminates subsidies available under Obamacare in favor of tax credits. The credits would range from $2,000 for people in their 20s to $4,000 those older than 60. To encourage people to maintain insurance, the bill prohibits “insurance companies from cutting them off or charging more for pre-existing conditions as long as their insurance doesn’t lapse. If coverage is interrupted for more than 63 days, however, insurers can charge people a 30% penalty over their premium for one year,” NPR reported.

Because there has been no analysis of the new bill, the final cost of insurance is debatable. The Kaiser Family Foundation tried to quantify the costs by creating an interactive map that illustrates what people in different parts of the country would pay for insurance. “The map shows that a 27-year-old who makes $30,000 a year would see costs rise about $2,000 in Nebraska but fall by about the same amount in Washington state. A 60-year-old, however, would see costs rise almost everywhere, with increases of almost $20,000 a year in Nebraska,” NPR said.

For individuals, the bill eliminates taxes that were part of the Affordable Care Act. These include taxes on incomes over $200,000 for individuals or $250,000 for a married couple. It also rolls back the 3.8% tax on investment income and taxes on medical devices, tanning salons, and prescription medications.

Medicaid would change dramatically under the plan. Obamacare expanded the program, which provides healthcare for the poor and disabled, to include nondisabled adults with incomes just above the poverty line. Nearly 10 million people received health care under this program. Under the Republican House bill, federal reimbursement of the program will be cut, starting in 2019. In its place, the bill would provide money to states in the form of a grant program, giving each state either a set amount of money per Medicaid enrollee or to receive a block grant to distribute as it saw fit.

While Obamacare is an individual market insurance program, as is the AHCA, it could have ripple effects on employer-based plans. According to some experts, states that opt out of the essential health benefits could open the door for employers to do the same with their plans, reducing benefits to employees. The waivers could also allow insurance companies to reinstitute annual and lifetime benefit limits, the Brookings Institute said, which are banned under the Affordable Care Act.

Brian Straight

Brian Straight has covered the U.S. trucking and transportation community for more than 10 years, winning numerous regional and national editorial awards, including a Jesse. H. Neal Award. Prior to working on FreightWaves, Brian spent 10 years at industry trade magazine Fleet Owner, and prior to that managed daily newspaper editorial operations.