The course of possible changes in the health insurance system in the United States has been a long one.  Preparing for changes in health insurance is not a new thing, and there are no sure guarantees right now as to what will happen with it. However, that is not going to stop you or the people you provide policies for from having questions.

There has not been a successful vote on any particular edit of the health care bill as of yet.  However, there are many reoccurring proposed solutions in each one. Regardless of what the future of health care becomes, it helps being aware of the contents of the three acts:

  • The House’s Affordable Health Care Act (AHCA)
  • The Senate’s Better Care Reconciliation Act (BCRA)
  • The current Affordable Care Act (ACA)

Knowing the basics of each of these can only help when your current and future clients come to you with questions.


Changes to Medicaid has been a large part of the health care overhaul. With the number of people covered by Medicaid under the ACA, the differences that the BCRA or the AHCA lead to are wide.

Medicaid Under ACA

  • Federal and state governments share the cost of health coverage through Medicaid. The federal government covers on average ninety per cent of the cost
  • Medicaid covers all low-income adults without children in the states that expand their programs
  • Each state receives funding for Medicaid dependent on the medical care their Medicaid patients receive
  • No wait lists or caps

Medicaid Under BCRA

  • The phasing out of the ACA Medicaid expansion over a four-year period
  • States will received ninety per cent of the current federal Medicaid funding in 2020. The amount of funding decreasing by 5% annually until it terminates in 2023
  • In 2025 Medicaid expansion ends. Gauging of spending will convert from the consumer price index for medical care to the CPI for all goods
  • No guarantee of coverage, but the use of wait lists and caps is available

Medicaid Under AHCA

  • Medicaid's replacement with a fixed per capita cap would result in federal funding capped per each enrollee, and fixed with pre-set growth per enrollee
  • Medicaid's replacement with a block grant would result in federal funding capped and fixed with pre-set growth
  • Certain groups may have guaranteed coverage

Insurance Costs

The price of coverage for Americans in the future, depending on each plan's criteria, leads to many different options regarding how it affects people and how affordable it is for them

Insurance Costs Under ACA

  • Americans who make less than 48k a year receive subsidies to purchase insurance in the healthcare marketplace. Out-of-pocket assistance is available for those as 100-250% of the Federal Poverty Level
  • The basis of the subsidies will be the individual’s income and insurance cost in their area
  • The subsidies will occur through monthly insurance bills instead of taking the form of a rebate

Insurance Costs Under BCRA

  • Personal income will be a factor for financial aid coverage but capped at 350% of the Federal Poverty Level. Out-of-pocket assistance is available on a per-month basis until 2019
  • Cost share subsidies for insurers to cover deductibles and co-payments would end by 2020
  • The federal government will allocate $70 billion to help insurance companies cover people with high medical costs

Insurance Costs Under AHCA

  • Age will be a basis for tax credits eligibility
  • Subsidies will be available, phasing out at annual incomes of $75,000

Required Coverage

The mandatory purchase part of the AHA has been one of the more criticized portions of the current health care law. Both the House and Senate proposals seek to remove the mandate through different solutions.

Required Coverage Under ACA

  • Maintenance of health care coverage must be either by the person or by their employer, or a monthly exemption must be active, otherwise, there will be the levying of an annual tax penalty

Required Coverage Under BCRA

  • Termination of the annual tax penalty
  • Setting of a six-month waiting period to purchase a new plan for people who have a gap in health care coverage for sixty-three days or more in the previous year

Required Coverage Under AHCA

  • Termination of the annual tax penalty
  • Setting a six-month waiting period to purchase a new plan for people who have a gap in health care coverage for more than two months at any time

Pre-existing Conditions

The elimination of pre-existing conditions was uniform with the signing of the ACA. Both the House and Senate proposals maintain coverage of pre-existing conditions, but both a conditional.

Pre-existing Conditions Under ACA

  • Pre-existing conditions cannot be a reason for denial of coverage, nor can charging of higher insurance rates occur because of them

Pre-existing Conditions Under BCRA

  • Pre-existing conditions coverage will continue
  • State-based waivers can exclude specific conditions from lifetime and annual limits
  • People in the same age bracket on the same plan will not pay higher premiums or have to take part in cost sharing

Pre-existing Conditions Under AHCA

  • Pre-existing conditions coverage will continue
  • State-based waivers can exclude specific conditions from lifetime and annual limits

The Marketplace

How any legislation will affect the marketplace is not easy to predict. The health insurance marketplace under the ACA provides the chance for Americans to compare plans side-by-side in order to choose the best plan. Both the AHCA and BCRA do not allow ways to predict how marketplaces would work because insurers are not obligated to offer the same basic packages as the ACA.

Health Care Changes to the Industry

As both proposals would alter or eliminate fundamental elements of current AHA legislation, the health insurance industry itself faces some big changes. You should watch the range of coverage offered and what it will cost, as those are two of the prime areas.

Range of Coverage

Both the BCRA and AHCA would probably result in a reduction in health care services overall. The ACA marketplace has plans that, while they may provide services that others do not, are all required to provide specific services. The ability for states to get waivers on providing what are now essential benefits may create uncertainty in an already competitive field.


With both proposals, the lack of financial protection for people with pre-existing conditions exempted by state waivers creates a cost issue. These people could put out of the health care market by an inability to purchase a plan that fits their needs. Americans who get coverage through their employers wouldn’t be affected as much compared t0 those who purchase their own plan, but given the number of elderly and poor that could be priced out, the insurance industry overall could see a significant drop in policies sold.

How AHCA Affects You

Changes in health care could create many changes in how you approach your profession, from lead generation to the policies you provide.


The challenge of getting the most out of your leads can be high in the best of times. Given the effect of either proposal on the stability of the insurance industry, you could find yourself having to change your approach to lead generation and maintenance even more. Depending on your territories you operate in, you can prioritize your leads based on the coverage criteria a particular state has. QuoteWizard health insurance leads provide extensive filtering power to help you in optimizing your leads and your conversion rate.

Customer Concerns

The uncertainty of what the future holds for health care is something that can affect both your current policyholders and future clients. Simply put, keep your educator hat handy. Your current clients will want to know what parts of their coverage changes and what they need to do to maintain their peace of mind. Nothing is written in stone as of yet, but if you can be familiar with the elements discussed in this article and have solutions available that satisfy their concerns, you can strengthen your long-standing relationship.

With people looking for a new policy, being aware of their personal details in relation to the solutions you can provide becomes more important. Even if required health insurance is no longer mandatory, you know that people need still need it. Knowledge of the range of plans available that optimize cost and coverage, as well as being able to offer advice to make getting insurance as easy as possible, will make you stand out in what is sure to be a highly competitive market.

Policy Management

Upon passing of a health bill, things could get busy on your part. Knowing the effects on your client’s policies and taking the time to connect with them with an offer to educate them on the changes will help avoid situations that they do not know about until too late, and make you a valuable asset for their health care needs.