Much of the talk on healthcare reform has been about how it will affect people who get their health insurance through Medicaid or the individual marketplace, but the majority of Americans -- some 56 percent -- get health insurance through their employers.

So, many of those folks are wondering whether the House Republican plan to repeal and replace Obamacare will impact them.

"I think to some degree it will affect everyone, even those who are insured and have been insured for years," said Carrie Krieger, Vice President of Juster & Associates, an insurance agency.

  • Out-of-pocket limits could increase to $10k per year or more
  • Majority of Americans get health insurance through employer
  • Senate expected to make major changes to House health care bill

Out of Pocket Limits

Krieger sells health insurance to employers and says workers could lose certain benefits if protections for those benefits are eliminated.

"Right now, under the Affordable Care Act, there are limits as to what the maximum annual out of pocket cost can be to a consumer," she said.

If the legislation passes, we could see those out-of-pocket limits increase from about $6,000 a year to $10,000 or more -- similar to pre-Obamacare amounts, but Krieger says it won’t affect most employees.

"Really and truly, people probably don't get there," Krieger said. "That's for very sick people. The average person isn’t going to scratch the surface of that, but it’s one way to kind of get a grasp on the costs. To say—‘potentially, you’re responsible for more of the cost, if something catastrophic happens.’”

 

Cost for Older Americans

In addition, right now, there are limits on how much people ages 50 to 64 can be charged for health insurance, but that could also change.  Insurers generally charge these pre-Medicare Americans more, because they are in an age-range when many medical problems can develop.  

Pre-Obamacare this age group could be charged around nine times more than younger Americans, but the Affordable Care Act limited that to three times more.  With the new bill proposed, that amount could increase again.

“Now they’re talking about making it a five-to-one ratio. So older people will pay a little bit more,” Krieger explained. “And that’s statistically related, because of the fact that if something is going to happen, it’s probably going to happen at age 53-54 or older.”

Employees generally did not see a significant impact from the cost differential, because it was mainly paid by their employers, but any increase in cost can trickle down to workers who pay a portion of their monthly premium.

Across the country, the Kaiser Family Foundation found the average percent of health insurance paid by employers is 83 percent for single coverage and 72 percent for family coverage, so that means the average that employees contribute is 17 percent for single coverage and 28 percent for family coverage.

 

Concern over Pre-existing Conditions

There has been a lot of concern about coverage of pre-existing conditions with the proposed reforms, but that is only expected to apply to those who don't maintain continuous coverage. So, if you're an employee and you have coverage, you should be OK.

However, if you leave your job and don't sign up for another plan, you could be impacted.

If you go without coverage for more than 63 days, you could pay more for pre-existing conditions -- for about a year -- as a way to promote continuous coverage and personal responsibility.

"It's analogous to saying you don't buy into coverage for homeowner's insurance when the house is on fire," Krieger said. "It's the same sort of thing."

Essentially, the law would do away with the individual mandate and penalties, in exchange for not covering pre-existing conditions for a period of time, unless a person maintains continuous coverage.  Krieger says it’s a way to prevent someone from taking advantage of the system, if they did not contribute to it.

 

Employer Mandate

The GOP House plan would also eliminate the mandate for large employers to offer health insurance to workers, but Krieger says it’s unlikely that most employers would stop offering it.

“Here’s the reality of it,” Krieger said. “Employers see it as a good way to get good people in the door and to keep good people. It’s part of the comprehensive benefit package.”

 

On to the Senate

On Wednesday, the Congressional Budget Office is set to release its analysis and score of the proposed healthcare bill that passed the House.  The report could have a major impact on efforts to get it through the Senate.  Whatever those findings, the Senate is expected to make significant changes to the proposed American Health Care Act, before anything final could be agreed upon.