AHCA – American Health Care Act – Synopsis – Summary


I found this on the web a couple of days ago.  It’s taken me that long to review it against the text of the AHCA.  It seems to hit the nail on the head.  At least I couldn’t find any discrepancies between this synopsis (summary) of the American Health Care Act and the act itself.  Disclaimer:  You should probably read the Act yourself.

And Remember:  If you want to obtain or switch insurers, you have less than two months to sign up before you run the risk of being put into a high risk pool.  Most states have such pools.  Some do not!  Better to act now!

Here’s the text:

Let me begin this post by saying I am a licensed Independent health insurance broker with 10 years of experience mostly in the Medicare, Group & Individual insurance markets. I represent my CLIENTS and myself, not one particular company or lobbying organization. My goal is to have happy customers and to be able to make a living with products that are valuable and affordable to people so they will want them.

The House GOP congress recently passed a bill to repeal and replace Obamacare this past week. It is called the AHCA or “American Health Care Act”. Partisan politics has once again reared its ugly head and the Democrats are using scare tactics and outright lies (much like they did to pass Obamacare) to try and dissuade people from supporting this bill. Much has been made about “Pre-Existing Conditions” and how this bill would supposedly not protect those consumers. This is an outright LIE. I will explain what Pre
Existing condition really means, who it applies to and what options are available pre Obamacare, during Obamacare and if this bill passes the senate, post Obamacare under this new bill.

What are “Pre Existing Conditions” and who does this apply to?

The Democrats with their overtly theatrical rhetoric would have you think that Pre Existing Conditions applies to everyone with a hangnail and that those mean Republicans will have every person in the country re-evaluated for hangnails and thrown off their current insurance plan if a hangnail is found.

This is of course NOT TRUE.

First of all, Pre-Existing conditions don’t even apply to about 85% of consumers. If you are one of the following, then the new law will NOT affect you AT ALL:

•If you have Medicare or a Medicare Advantage plan
•If you have VA Benefits or Tri-Care
•If you have health insurance through your Employer
•If you have Medicaid and are below the Federal Poverty Level
•If you currently have individual or group health insurance and do not allow a 63 day gap in coverage from your current plan to your next plan.

Thats the majority of people in the country. So the majority of people in the country will NOT be affected by the Repeal & Replace of Obamacare’s Pre Existing Conditions law.

So that begs the question. Who will be affected by these changes and how?

The people that will be affected by these changes are people who:

•People who do NOT have insurance through Medicare, Medicare Advantage, Va benefits, Tri Care,or Medicaid below poverty level (ie they are not on any government program) and allow their current insurance to expire and do not secure new coverage within 63 days.

This would be people who are under 65, not veterans and not disabled and they allow their current insurance to expire and then do not get new coverage within 63 days.

What happens to these people if they allow their insurance to expire and don’t new coverage in 63 days?

So whats next for these people? Do they get sent to Mars? Do we let them die in the streets? Of course not.

These people will be eligible for High Risk Pool Insurance through their state, backed the federal government. If they wait more than 63 days to get coverage and are denied new coverage due to a Pre existing condition they will get a letter telling them how to apply for the high risk pool plan to get guaranteed insurance.

So alas, they will NOT be left out in the cold to die like the Democrats would like you to believe.

Will they pay more for this coverage had they not waited?

They might, depending on their states rules. Some states have subsidies based upon income to help people afford the high risk pool plan premiums. They might also have broader access to doctors and hospitals then if they were stuck in their old HMO so there could be a silver lining there as well. High risk pool plans were largely successful Pre Obamacare. The problem was there were only 33 states that offered them so 17 states did not have this option before. All 50 states will have this option under the Republican plan.

What is a Pre Existing Condition?

So what is a Pre Existing condition anyways?

Its definitely not a hang nail. Its not even high cholesterol. The only Pre existing conditions underwriters take into account when deciding the issue coverage or not are conditions like Diabetes or Cancer for example. Some companies will insure conditions like Epilepsy, others won’t. Some companies will issue a policy covering everything except the Pre existing condition or some companies may have a waiting period for the Pre existing condition to be covered.

In any case, there will always be the high risk pool plan options if people get denied.
Nobody will ever be left in the cold.

Also its important to remember that people with Diabetes and Cancer and other serious conditions cannot be denied coverage if they already have insurance. They cannot be kicked off their current plans and they cannot be denied by an insurance company if they do not allow their current plan to lapse more than 63 days without a new plan.

Also remember this NEVER applies to folks on Medicare, Medicaid or Tri Care or with VA benefits or anyone obtaining insurance through their employer. Pre Existing conditions never apply to those people.

What other changes are in this law? Will it help or hurt anyone?

Now that we have covered Pre Existing Conditions, what else is in this bill and how will it affect people?

•Insurance Companies can offer more types of plans. With the elimination of mandated benefit packages, you will have more choices to choose the type of plan you want, what you want it to cover and how high or low you want your deductibles.
•Abortions are no longer mandated coverage.
•Medicare & Medicare Advantage funding will increase and has been restored to pre Obamacare levels. Originally Obamacare had stolen about $700 billion from Medicare to pay for subsidies for non disabled adults to get their premiums subsidized. This will help the folks on Medicare & Medicare Advantage.
•Medicaid will only be for people below the poverty line. The Medicaid expansion under Obamacare had people making over poverty level getting Medicaid benefits. This will cease.
•There will no longer be a government mandated IRS fine/penalty for not buying insurance.
•If you wait more than 63 days to buy new insurance from your old insurance a company can elect to charge you 30% more on your premium. Its best to be a responsible adult and keep your insurance if you can.
•With people with Pre existing conditions now in high risk pools, the regular insurance market for those without Pre existing conditions just got alot cheaper.


In conclusion this bill stops robbing Peter to pay Paul. It is much more fair in its pricing laws and it ensures every American has access to health insurance without a heavy emphasis on redistributing wealth and rewarding bad behavior. This bill rewards responsible behavior while still protecting our most vulnerable.

If you feel this DETAILED review of the new federal healthcare legislation is helpful, and counters all the crap we’ve been seeing from mudstream news, please share it.

Thank you.

Author: patriot

It was a distinct honor, as well as my pleasure, to serve my country for more than twenty years. I love my country, but sometimes I'm not too happy with its leaders. I'm working to change that, and I could use your help. Please join me! Thanks. : ) - Patriot

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