Think your insurance you get from work is safe from AHCA? Think again.

Tom Taylor holds a Ph.D in robotics and is running as a Democrat in Utah’s 4th Congressional District. To find out more about his campaign or to make a donation, please visit www.tomforutah.com. He can also be followed on Twitter @TomForUtah.

When the CBO score for the 2nd AHCA was released, the numbers were devastating.

14 million to lose insurance in 2018. Populations of New York City and Los Angeles combined are about 12.5 million.

23 million to lose insurance after the first decade. Taiwan has a population of about 23.5 million.

A 64-year-old making $26,500/year could see premiums rise from $1,700/year to $16,100 or 60% of their income.

Although these numbers are disgusting, I would like to write on the effect that the AHCA will have on people that get their insurance through their employer. As we inch closer to the Senate passing a version of this bill, it is important to keep in mind that the Affordable Care Act affects you even if you don’t get your insurance through healthcare.gov or Medicaid.

The ACA set up what are called essential health benefits and they are as follows (from healthcare.gov):

Ambulatory patient services (outpatient care you get without being admitted to a hospital)

Emergency services

Hospitalization (like surgery and overnight stays)

Pregnancy, maternity, and newborn care (both before and after birth)

Mental health and substance use disorder services, including behavioral health treatment (this includes counseling and psychotherapy)

Prescription drugs

Rehabilitative and habilitative services and devices (services and devices to help people with injuries, disabilities, or chronic conditions gain or recover mental and physical skills)

Laboratory services

Preventive and wellness services and chronic disease management

Pediatric services, including oral and vision care (but adult dental and vision coverage aren’t essential health benefits) Additionally, birth control and breastfeeding services must be covered.

Additionally, the Affordable Care Act banned insurance companies from enacting annual and lifetime limits as well as required them to cap an enrollee’s annual out-of-pocket spending. Lifetime limits were a way for insurance companies to deny care to someone once they had already received “too much” healthcare over the course of their life — children that get leukemia could find themselves in a position where they have “used up” all of their insurance claims and then have to navigate the rest of their lives without health insurance. Caps on out-of-pocket spending ensured that insurance companies would cover everything past a certain point. For example, if the max out-of-pocket was $5,000, once you spent that in a year in deductibles, the insurance company was required to cover every dollar past that.

What voters need to understand is if the AHCA passes, every single one of these benefits will likely disappear if they get their insurance through their employer. The AHCA allows states to apply for waivers so that insurance companies can choose whether to offer these benefits. Each of these benefits cuts into an insurance company’s bottom line, so there is a strong incentive to get rid of them. Surely you will be safe if the state you live in decides not to get this waiver, right?

Wrong. Here’s why.

Due to the complexities of large companies that employe people across multiple states, the benefits that are given to employees can be any plan that is available in a state that the company has its headquarters in. Essentially, companies can choose the skimpiest plan that they can find out of any state in the country, put their headquarters in that state (even if it’s just a P.O. Box), and then offer that skimpy plan to all of their employees. Under the ACA this wasn’t a big deal because the ACA required every plan to cover these essential health benefits. However, under AHCA, a state can apply for a waiver on these benefits so that means if only one state decides to obtain the waiver it will allow companies to set up their headquarters in that state and provide that skimpy insurance to employees nationwide.

It’s worse than that, as explained by Matthew Fiedler of Brookings:

...the ACA’s ban on annual and lifetime limits only applies with respect to care that is considered essential health benefits. Similarly, the ACA only requires that plans cap enrollees’ annual out-of-pocket spending on care that is considered essential health benefits. Thus, as the definition of essential health benefits narrows, the scope of these requirements narrows as well. Indeed, if nothing was considered an essential health benefit, then these requirements would be completely meaningless.

In conclusion, you are not safe if you get your health insurance through your employer. Worse, if you live in a state that does not apply for the waiver, but you get your insurance through your employer, it is likely that you will get worse insurance than is found on healthcare.gov in your state. It’s like some kind of cruel joke.