Â鶹ŮÓÅ

This week, I answerÌýquestionsÌýabout how the Republican proposal to overhaul the health law could affect job-based insurance and what the penalties for not having continuous coverage mean.ÌýPerhaps anticipating a spell of uninsurance, another reader wondered if people can rely on the emergency department for routine care.

Q: Will employer-based health care be affected by the new Republican plan?

The Ìýthat recently passed the House would fundamentally change the individual insurance market, and it could significantly alter coverage for people who get coverage through their employers too.

KHN contributing columnist Michelle Andrews writes the series , which explores health care coverage and costs.

To contact Michelle with a question or comment, .

This KHN story can be republished for free (details).

The bill would allow states to opt out of some of the requirements of the Affordable Care Act, including no longer requiring plans sold on the individual market to cover 10 “,” such as hospitalization, drugs and maternity care.

Small businesses (generally companies with 50 or fewer employees) in those states would also be affected by the change.

Plans offered by large employers have never been required to cover the essential health benefits, so the bill wouldn’t change their obligations. Many of them, however, provide comprehensive coverage that includes many of these benefits.ÌýÌý

But here’s where it gets tricky. The ACA placed caps on how much consumers can be required to pay out-of-pocket in deductibles, copays and coinsurance every year, and theyÌýapply to most plans, including large employer plans. In 2017, the is $7,150 for an individual plan and $14,300 for family coverage.ÌýYet there’s a catch: The spending limits apply only to services covered by the essential health benefits. Insurers could charge people by the states.

Similarly, the law prohibits insurers from imposing lifetime or annual dollar limits on services — but only if those services areÌýrelated to the essential health benefits.

In addition, if any single state weakened its essential health benefits requirements, it could in every state, analysts say.ÌýThat’s becauseÌýthese employers, who often operate in multiple states, which state’s definition of essential health benefits they want to use in determining what counts toward consumer spending caps and annual and lifetime coverage limits.

“If you eliminate [the federal essential health benefits] requirement you could see a lot of state variation, and there could be an incentive for companies that are looking to save money to pick a state” with skimpier requirements, said Sarah Lueck, senior policy analyst at the Center on Budget and Policy Priorities.

Q: I keep hearing that nobody in the United States is ever refused medical care — that whether they can afford it or not a hospital can’t refuse them treatment. If this is the case, why couldn’t an uninsured person simply go to the front desk at the hospital and ask for treatment, which by law can’t be denied, such as, “I’m here for my annual physical, or for a screening colonoscopy”?

If you are having chest pains or you just sliced your hand open while carving a chicken, you can go to nearly any hospital with an emergency department, and — under the federal (EMTALA) — the staff is obligatedÌýto conduct a medical exam to see if you need emergency care. If so, they must try to stabilize your condition,Ìýwhether or not you have insurance.

This KHN story also ran on . It can be republished for free (details).

The key word here is “emergency.” If you’re due for a colonoscopy to screen for cancer, unless you have symptoms such as severe pain or rectal bleeding, emergency department personnel wouldn’t likely order the exam, said Dr. Jesse Pines, a professor of emergency medicine and health policy at George Washington University, in Washington, D.C.

“It’s not the standard of care to do screening tests in the emergency department,” Pines said, noting in that situation the appropriate next step would be to refer you to a local gastroenterologist who could perform the exam.

Even though the law requires hospitals to evaluate anyone who comes in the door, being uninsured doesn’t let people off the hook financially. You’ll still likely get bills from the hospital and physicians for any care you receive, Pines said.

Q: The Republican proposal says people who don’t maintain “continuous coverage” wouldÌýhave to pay extra for their insurance. What does that mean?Ìý

Under the bill passed by the House, people who have a of more than 63 days in a year would be hit with a 30 percent premium surcharge for a year after buying a new plan on the individual market.

In contrast, under the ACA’s “individual mandate,” people are required to have health insurance or pay a per adult. They’re allowed a every year before the penalty kicks in for the months they were without coverage.

The continuous coverage requirement is the Republicans’ preferred strategy to encourage people to getÌýhealth insurance. But some analysts have questioned how effective it would be. They point out that, whereas the ACAÌýpenalizes people for not having insurance on an ongoing basis, the AHCA penalty kicks in only when people try to buy coverage after a break. It could actually discourage healthy people from getting back into the marketÌýunless they’re sick.

In addition, the AHCA penalty, which is based on a plan’s premium, would likely have a greater impact on older people, whose premiums are relatively higher, and those with lower incomes, said Sara Collins, a vice president at the Commonwealth Fund, who authored an analysis of the impact of the penalties.

Please visit to send comments or ideas for future topics for the Insuring Your Health column.

Â鶹ŮÓÅ Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at Â鶹ŮÓÅ—an independent source of health policy research, polling, and journalism. Learn more about .