Kitchen Table: Dealing with the Cost and Complexities of Healthcare

Healthcare coverage, medical expenses and debt are some of the top financial concerns of American families. In the United States, medical bills are the leading cause of bankruptcy. 66% of all bankruptcies in the US were related to medical issues.  

It is estimated that over 100 million Americans owe at least $220 billion in medical debt. In 2021, 23% of U.S. adults had one or more unpaid and past due bills from a medical service provider. 

Medical Care is Far Too Complicated
Medical coverage is complicated, as we are structured for more employer-based plans offered by private insurers. If you work independently, for a small business with less than 50 employees, work part-time, or are in between jobs, getting coverage can be costly. The dance we go through with changes in premiums, coverages, deductibles, total out-of-pocket maximums, in-network, out-of-network, pre-approvals, referral requirements, navigating care and claims is extraordinarily complex and with the ever-nagging thought, when will I get a surprise?  
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The difference in the GOP-Trump-Project 2025 plan and the current and proposed changes by the Biden-Harris team is stark and a lot is at risk in this election.

Key Takeaways

• Trump’s “concept of a plan” is effectively the elimination of the ACA, including its consumer protections such as no discrimination based on pre-existing conditions, discussed below. Replacing the ACA has been a Trump goal since his last term in office.  
• The Biden-Harris administration looks to keep and expand access to the ACA including making permanent the expanded ACA subsidies and keeping in place the consumer protections.
• The Biden-Harris administration issued an executive order promoting competition, released updated merger guidelines, and has challenged anticompetitive behavior in the health care sector.
• The Harris-Walz campaign looks to restore a national standard of abortion, improve pregnancy care and guarantee the right to IVF.

The GOP Wants to Eliminate the Affordable Care Act
For those who work independently, work for small businesses with fewer than 50 employees, work part-time or are in between jobs, the Affordable Care Act is the most utilized way to gain access to healthcare and take the bite out of healthcare costs. In 2024, this represented 45 million Americans, 1.3 million of them from Georgia. 
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The Affordable Care Act has 3 primary components:

• Through either state-run or federally-run marketplaces (healthcare.gov), offer ACA-compliant individual or family policies coming from approved providers;
• Offer income-based subsidies of healthcare premiums;
• Provide a series of consumer protections that benefit EVERYONE, whether they use the marketplace policies, employer-employee funded policies or individual policies offered by insurance companies.

Consumer Protection Provisions that Apply to Us All
No Discrimination Based on Pre-existing Conditions: Insurers cannot deny coverage or charge higher premiums based on pre-existing health conditions.

Essential Health Benefits: The ACA requires that all health insurance plans sold on the Health Insurance Marketplace cover a set of ten essential health benefits, including emergency services, maternity and newborn care, mental health and substance use disorder services, prescription drugs, and preventive services including contraceptive coverage.

Limit on Out-of-Pocket Costs: The ACA places limits on out-of-pocket maximums for health coverage, which protects consumers from high medical costs.

Preventive Services Coverage: Insurance plans are required to cover certain preventive services without charging a copayment or coinsurance, such as vaccinations and screenings.

Ban on Lifetime and Annual Limits: Insurers cannot impose lifetime or annual limits on most benefits, ensuring that individuals do not lose coverage when they reach a certain amount of benefits.

Clear and Transparent Information: The law mandates that insurers provide clear and concise information about health plans, including coverage details and costs, to help consumers make informed choices.

Young Adult Coverage: Young adults can stay on their parents’ health insurance plan until they turn 26, providing extended coverage during early adulthood.

No Gender Rating: Insurers cannot charge higher premiums based on gender, helping to reduce cost disparities.

Grievance and Appeals Process: The ACA requires that health plans have a process for consumers to appeal coverage decisions, allowing individuals to challenge claims that are denied.

Consumer Assistance Programs: The law provides for support programs to assist consumers in understanding their coverage, assisting with enrollment, and addressing issues with their insurers.
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Additional Resources:
To see an updated comparison of health policy between Trump and VP Harris by KFF, click here.
To see the impact of Medicaid and Medicaid expansion in Georgia, check out our May 30th edition of The Kicker.