The Call-In: Answering Your Questions About The Republican Health Care Plan

LOURDES GARCIA-NAVARRO, HOST:

And this is The Call-In. After the long-awaited GOP health plan was released, there were reactions from both sides of the aisle. But for many people, what lingered were their questions.

MELISSA MCSWIGGAN: Hi, my name is Melissa McSwiggan. I'm calling from Pittsburgh, Pa.

HERMANN VOGELSTEIN: This is Hermann Vogelstein in Rochester, N.Y.

UNIDENTIFIED WOMAN #1: From Hilo, Hawaii.

MCSWIGGAN: And I have a comment (inaudible) about the new Republican plan.

UNIDENTIFIED WOMAN #2: Why are we not talking about a traditional Medicare model for all?

VOGELSTEIN: Would those on Medicaid get a tax credit?

UNIDENTIFIED WOMAN #3: How will it work for employers? Thanks very much.

VOGELSTEIN: Thank you very much.

MCSWIGGAN: OK, bye.

GARCIA-NAVARRO: We asked you what you wanted to know about how the Republican health proposal would affect you. NPR's Gisele Grayson runs NPR's health reporting project with member stations and Kaiser Health News. And she has been following the bill, so she joins us now to answer your questions. Big subject, tough one. I don't envy you. Hi, Gisele. How are you?

GISELE GRAYSON, BYLINE: (Laughter) I must say, when I saw these questions I was so happy because I'm like, wow, I'm going to learn things that I, you know, hadn't dived into before. So let's do it.

GARCIA-NAVARRO: All right. Let's start with this question from Louise Young. She left us a voicemail.

LOUISE YOUNG: How would people who currently get subsidies pay for their premiums? Currently with the subsidy, their premium is reduced upfront. With tax credits, how would that work?

GARCIA-NAVARRO: So right now people are, under the Affordable Care Act, getting subsidies. They're getting tax credits to pay for the expenses of health care. And she's asking, how would it work under the Republican bill?

GRAYSON: What's going to be the same is there is going to be help for people. People are going to get tax credits. And it's going to work - the filing is roughly going to work the same way. Here's the big difference. In aggregate, it's going to be a lot less money. People are not going to probably get as much to pay for their premiums in the end. Plus there was another pool of money that the Affordable Care Act put aside to help people who really have low incomes. That pot of money is gone completely.

GARCIA-NAVARRO: All right, Louise also had a second question. Here it is.

YOUNG: If you're a large employer, you currently have to provide health insurance coverage at a very low cost for certain people based on your wage rates. What would happen to this provision in the law if the individual mandate goes away?

GRAYSON: All right, good question. There are two mandates in the existing Affordable Care Act. One is that people have to have insurance. And the other is that employers have to provide an offer of insurance that's some sort of reasonable percentage of their income. Both of those mandates go away under the GOP bill. A lot of people aren't actually particularly concerned about the employer mandate going away. I talked to a woman named Caroline Pearson. She's with the consulting firm Avalere Health. And here's what she said about the employer mandate and its impacts.

CAROLINE PEARSON: That does not necessarily mean that employers are going to start dumping coverage. You know, I think employers offer insurance for a lot of reasons. Most of them have nothing to do with the mandate. Except in sort of rare cases, I think most employers will continue to offer coverage.

GRAYSON: So I think as long as the economy is good and as long as employers like to dangle health insurance in front of people because people think it's pretty important, that will mostly stay intact.

GARCIA-NAVARRO: All right, another question for you, Gisele. Take a listen.

MARTY ALLEN: My name is Marty Allen. I'm going on to Medicare in April. I don't know how the Republican plan is going to affect Medicare, but I'm hearing here and there that it will. Do you have any answers to that question? I realize it's rather large and broad, but I don't know how to make it more specific.

GRAYSON: That's a great question. So how about I make the answer large and broad and then try to get specific? Trump has said he is not going to touch Medicare. End of story. I'm putting that on the table. The bill does actually repeal some taxes that right now go to fund Medicare. That's actually more of a political problem. Politicians are going to have to figure out how to fund Medicare. I'm not sure somebody who's actually on Medicare is going to really feel that. But here's a sort of more nuanced answer. Medicare is the health insurance for people 65 and older, and it takes care of routine medical care. It will also take care if you need to go to the emergency room. You break a hip or something, you need to be hospitalized for a bit, that's Medicare.

Say you've got Alzheimer's and you need long-term care. That's actually Medicaid that pays for that. Medicaid pays for a lot of seniors who need longer term care - they're in nursing homes, they've got disabilities. And Medicaid under this bill is actually going to be cut substantially. And states, when they lose this money from the federal government, are going to have to make some pretty tough decisions about who they're going to cover.

GARCIA-NAVARRO: We got a number of good questions from Hermann Vogelstein up in Rochester, N.Y. Let's start with this one.

VOGELSTEIN: Would there still be online marketplaces to compare plans? Would plans still be classified by metal grades so shoppers would know that they're comparing apples to apples?

GRAYSON: All right. Yeah, this is actually a pretty big difference in this bill. There's not going to be a requirement. It'll probably depend on where you live. So you had to - in order to get the subsidies under the Affordable Care Act...

GARCIA-NAVARRO: You had to...

GRAYSON: ...You did have to go through healthcare.gov.

GARCIA-NAVARRO: And you'd have to see everything lined up and you could compare them. And then you'd go through the system there.

GRAYSON: Right.

GARCIA-NAVARRO: And this bill does what?

GRAYSON: That requirement is gone. You can buy insurance and get the subsidies without going through the exchange. Some states like California will probably try to maintain a pretty robust exchange and have all the offerings there. But other states that weren't so enamored with the Affordable Care Act, these exchanges might sort of fizzle out or not become as useful to a consumer because they won't have all the plans listed.

GARCIA-NAVARRO: All right. And here's another question from Mr. Vogelstein up in Rochester, N.Y.

VOGELSTEIN: Would there still be minimum standards of coverage under the proposed plan so people don't unwittingly buy junk plans only to find out that coverage is inadequate when they need it?

GARCIA-NAVARRO: Another really good question.

GRAYSON: Yeah, and another complicated answer - kind of. There are still some really strong consumer protections in place. The plans have to offer these essential health benefits. They have to offer minimum standards of coverage. The amount of money a consumer can spend out of pocket still remains capped. There are some provisions in the bill that will let insurers offer plans where you might have to pay a little bit more. They might have a little bit more discretion in tweaking some of the benefits. I'd say for the first few years we're going to see plans remain pretty robust. But this is definitely something to watch because the bill can't do too much right now. But Tom Price, the secretary of Health and Human Services, is going to have a lot of discretion in defining what makes a robust plan. So it's something to keep an eye on.

GARCIA-NAVARRO: NPR's Gisele Grayson. She runs NPR's health reporting project with member stations and Kaiser Health News. Thanks for running us through what is and will continue to be a very complicated issue.

GRAYSON: You're welcome.

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