Republican proposals will do nothing to protect people with insurance or help people who can’t afford coverage.

• No Protections for Those with Pre-Existing Conditions
  
  In many states, insurers are free to charge people who have pre-existing conditions more for coverage in the individual market or to deny them coverage entirely. Insurers are also often allowed to charge higher premiums based on an applicant’s health status.
  
  Republican proposals do nothing to require that insurers offer coverage to all Americans regardless of health status, they do not require health plans to cover pre-existing conditions, and they do prevent insurers from charging more to individuals who have pre-existing conditions. In contrast, proposals passed by both the House and Senate eliminate these unfair practices.
  
  
• No Regulation of Insurance Company Profits
  
  Health insurance companies are generally free to decide how much of each dollar that is collected in premiums will be spent on health care versus how much will go toward marketing, paperwork, and profits. This results in hundreds of billions of dollars being spent each year on non-medical costs.
  
  Republican proposals do nothing to reign in this insurance company practice. Furthermore, Republican proposals undermine existing state authority that would require that consumers receive value for their premium dollars. This will result in consumers paying hundreds of billions of dollars in inflated premiums each year. In contrast, proposals passed by both the House and Senate clamp down on insurance company practices, creating new rules that require insurers to spend a minimum percentage of premium dollars on health care and to provide refunds to consumers who are overcharged.
  
  
• No Review of Premium Increases
  
  Regulations that govern whether annual increases in health insurance premiums must be reviewed and approved to be reasonable vary widely from state to state. Some states review insurers' proposals to raise premiums (and may deny insurers’ requests for rate increases or require them to be scaled back), while other states do not.
  
  Republican proposals do nothing to require accountability and transparency from insurance companies when they set or raise premiums. Furthermore, Republican proposals undermine existing state authority to review premium rates and to ask insurers to justify premium increases. In contrast, proposals passed by both the House and Senate will establish standards for strong premium rate review in every state with opportunities for consumer input and the potential for consumer refunds.
  
  
• No Limits on the Out-of-Pocket Costs Faced by Insured Families
  
  Even when they have insurance, consumers often have to spend a great deal out of their own pockets to obtain the health care they need. These out-of-pocket expenses come in the form of deductibles, copayments, and other cost-sharing. Furthermore, many insurers place annual or lifetime caps on coverage, and they stop paying claims when those caps are reached. These problems can drive families into debt—and even bankruptcy.
  
  Republican proposals do nothing to protect families with insurance from the catastrophic financial consequences of high deductibles, high copayments, and health insurance plans that suddenly and arbitrarily terminate coverage if families require “too much” care. Furthermore, Republican proposals promote high-deductible plans and barebones plans that leave families more financially vulnerable. In contract, proposals passed by both the House and Senate require that all plans include caps on how much insured families have to spend out of pocket per year on health care and don’t allow insurers to terminate coverage because you meet their limit on what they are willing to pay for your health care.
  
  
• No Help with the Cost of Insurance for Low- and Middle-Income Families
  
  The rising cost of health insurance premiums has made coverage unaffordable for many hardworking American families. Premiums have risen dramatically over the last decade, and workers’ wages have not been able to keep up with these increases.
  
  Republican proposals do nothing to help families deal with escalating insurance premiums that are rising five times faster than median worker earnings. Furthermore, Republican proposals will lead to even higher premiums, especially for families with members who are in less-than-perfect health. In contrast, proposals passed by both the House and Senate will provide robust premium subsidies that protect low- and middle-income families (a family of four with income up to $88,200 would never pay more than 9.8 percent of the family income for family insurance coverage; families below this level would pay even less).

Next: Republican proposals will do nothing to help people on Medicare with out-of-pocket costs.

[Back to Summit Watch main page]