$200,000 NICU Bill Proves Why The AHCA Won't Work

by Casey Suglia

The American Health Care Act is steps away from becoming a law. Even with insurance, medical care in the United States is already expensive enough. But with the AHCA, coverage could come at a major cost. Already, people are struggling to meet the cost of medical care, and this family with a $200,000 NICU bill proves why the AHCA would be devastating for families with children.

Amy and Mac Jay's story is a cautionary tale as to how the cost for medical procedures could skyrocket under the AHCA. Under the Affordable Care Act and with an insurance policy that they were paying for themselves, the Jays welcomed a second daughter, who was born premature and had to spend the first two weeks of her life in the NICU, according to Babble. Once the baby was healthy, the family received a major bombshell — a bill from the hospital for $178,389.47.

The Jays claimed that the insurance company had refused to cover any of the family's medical expenses. Apparently, though Amy had double checked, there had somehow been a lack of communication between the insurance company and the Jay family, which left their new baby uninsured, and the family was left with the massive medical bill.

The Jay family told Babble that they realize they're luckier than most, and that friends and family are there to support them, but they've since considered filing for bankruptcy; Though they've spoken with lawyers, they claim the insurance company "won't budge", according to Babble. Now, they're left in a situation that, unfortunately, may become more common if the AHCA is passed in its current form.

For instance: The Jays' daughter, at only 2 weeks old, racked up a costly medical bill which they will now likely have to pay out of pocket for the rest of their lives. The AHCA brings back lifetime limits — limits set by insurance companies that cap the amount of benefits that one person can receive in their lifetime. For children in and out of hospitals with chronic conditions, or those like the Jays' daughter who lived the first few weeks of her life in a medical facility, this cap stays with them, making their lifetime medical care for a condition they were born with, incredibly expensive.

Also compounding the problem: Hypothetically speaking, if Amy Jay had become pregnant under the AHCA, and was looking for health insurance, she could have been charged even more for that insurance; Under the AHCA, pregnancy could be considered a pre-existing condition, which means insurance companies could have charged her much higher premiums for general services and medications related to that "condition" — in addition to not covering her delivery.

The Jay's young daughter, meanwhile, could have a hard time affording her medication for her respiratory issues, should the AHCA be passed in its current form, as it gives states the option to waive out of the essential health benefits, which require pre-existing conditions like respiratory disease to be covered (in other words, the family could be paying out of pocket costs for her prescription drugs). This would, again, only drive up the cost of the family's medical bills overall.

Luckily, the Jays were able to get some help: A GoFundMe fundraiser to help pay their medical bills gave the family a good amount of money to help their issue — but even then, it's just under $26,000, a fraction of the overall cost.

Families shouldn't have to resort to using a GoFundMe every time they encounter medical problems or have children, full stop. Unfortunately, under the AHCA, more families might suffer the same fate anyway.