If you have employer-provided health insurance, an Obamacare repeal would affect you too

One of the first things Tracy Trovato did — once she overcame the shock of learning her 42-year-old, marathon-training husband had leukemia — was look through their health insurance documents.

She dug up one paper that said the plan would pay no more than $1 million for medical services in a lifetime. The Chicago woman and her husband, Carlo, called their insurance company in a panic.

“Our first question was, ‘Can we take care of leukemia in a million dollars?’” Tracy Trovato said. The woman on the other end of the line reassured them, saying, “The president took care of that. We don’t have maximum caps anymore,” Trovato recalled.

“Those were among the sweetest words,” said Trovato, whose health insurance is through her husband’s employer.

But now that ban on lifetime limits, along with other health insurance protections, has been thrown into question with the election of Donald Trump, who’s promised to repeal and replace the Affordable Care Act, also known as Obamacare.

In recent weeks, much attention has focused on what repealing and replacing the law might mean for the nearly 20 million Americans who get health insurance through the law’s exchanges or Medicaid expansion.

But Obamacare is far broader than that. Scrapping it also could change how health insurance works for the 156 million Americans who have coverage through employers, as estimated by the Henry J. Kaiser Family Foundation.

In addition to banning lifetime coverage caps, the Affordable Care Act lets consumers keep children on their plans until age 26; requires companies with at least 50 employees to offer coverage; and makes preventive care, such as health screenings, flu shots, breast-feeding supplies and contraception, free to those with insurance.

Obamacare also bars insurers from denying coverage to people with preexisting conditions, though a shake-up of that requirement is more likely to affect those shopping for coverage outside of employer plans. Before Obamacare, a separate federal law generally prohibited plans offered by employers from withholding coverage because of preexisting conditions.

Republicans aren’t expected to immediately repeal the entire Affordable Care Act. They don’t have enough votes in the Senate to stop a filibuster over a repeal bill. Instead, many observers expect they’ll pass a reconciliation bill, which would enable them to roll back some, but not all, of the law’s provisions while they work on a full replacement.

Experts agree that some of Obamacare’s requirements are likely to stay and others are likely to go.

The requirement that companies with at least 50 full-time employees provide healthcare coverage is probably on its way out, possibly in a reconciliation bill, said Robert Moffit, a senior fellow at the Heritage Foundation, a conservative think tank.

Avik Roy, who served as a healthcare adviser to former presidential candidate Mitt Romney and founded the Foundation for Research on Equal Opportunity, said that requirement has led to a lot of problems, such as companies limiting their full-time hiring so as not to hit the 50-employee threshold.

Many experts, however, don’t expect a huge number of employers to suddenly drop their healthcare benefits in response.

Many firms will “continue offering coverage to their employees because employees insist on it,” said Nicholas Bagley, a law professor at the University of Michigan.

A different Obamacare requirement — that parents be allowed to keep children on their plans until age 26 — has proved to be popular and is likely to survive, said Larry Levitt, a senior vice president for special initiatives at the Kaiser Family Foundation.

Politicians haven’t spent much time discussing Obamacare’s free preventive services, which are likely to survive a reconciliation bill. But Levitt said he’d be surprised if whatever ultimately replaces Obamacare still includes that free access.

“The general direction of GOP replacement plans is less regulation of insurance,” he noted.

Levitt said he’d also be surprised if Obamacare’s ban on capping lifetime healthcare benefits continues. Roy said he could envision the federal government leaving the issue up to states if it chooses not to renew that requirement.

Barring such limits means people don’t have to worry about their insurance coverage for serious medical issues. But Roy said it’s important to recognize that such a requirement, like many of the law’s other provisions, raises premiums for everyone. “There’s no such thing as a free lunch,” Roy said.

About 105 million Americans had plans with lifetime limits on their health benefits before the Affordable Care Act, according to the U.S. Department of Health and Human Services.

Trovato and her family were among that population.

They’re grateful they ultimately didn’t have to worry about running into a lifetime limit. Tracy Trovato stopped keeping track of the actual cost of Carlo Trovato’s treatment — paid for by their insurer — once it hit about $425,000 a couple of years ago.

The family feels fortunate that Carlo Trovato has been cancer-free for about three years. But he isn’t in the clear. He still has to get bone marrow biopsies every six months, and there’s a 15% to 20% chance of the cancer returning.

Tracy Trovato worries if the caps return, she, her husband and their two teenagers will be one more major medical issue or accident away from hitting a cap — from having to decide between forgoing healthcare and entering bankruptcy.

She never thought about the cap until her husband got sick, and she suspects many healthy Americans haven’t either.

“To me, we are all a real half a second away from a real terrible medical thing that would just devastate us financially,” she said.

lschencker@chicagotribune.com

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