GOP health care bill: Everything to know about plan
The House is scheduled to vote Thursday on the Republican plan to replace the Affordable Care Act. Here is a look at the impact of that legislation.
How would the bill change Obamacare?
People who don’t buy insurance would no longer be penalized. Larger employers would no longer have to offer coverage to workers.
The ACA’s expansion of Medicaid to people earning up to 138% of the federal poverty line ($16,400 for one person) would be phased out. States would also receive less money for their Medicaid programs, although they could gain new flexibility to run them — including limiting who is covered and what benefits are offered.
The tax credits to subsidize insurance premiums for people not eligible for a government program and not offered coverage through an employer would be changed. They would be worth about half as much as the current average subsidy within a decade. But people who are younger, higher-income and live in areas with low premiums would do better under the GOP bill while people who are older, have lower incomes and live in high-premium areas would be worse off. And the current subsidies that help pay for deductibles and co-payments would end.
Insurance companies could generally charge older customers five times as much as younger customers, instead of three times as much for the same plan.
What parts of Obamacare would not be changed?
Insurance companies could not deny coverage to sick people, but they could charge them higher premiums for a year if coverage lapses. Insurers would still have to provide specific health benefits, although the total share of expenses they have to pick up would be less.
Other popular Obamacare provisions that would not change include: no lifetime or annual limits on coverage, and young adults could still stay on their parents’ plans until they turn 26.
What changes were recently made to the bill?
Modifications released Monday by House GOP leaders included accelerating repeal of the ACA’s taxes; giving states the option of receiving Medicaid funding as a block grant that doesn’t increase with enrollment but comes with more spending flexibility; allowing states to require some Medicaid recipients to work; and expanding a tax deduction for medical expenses. Republicans said the funding for the latter provision could be shifted by the Senate to make premium tax credits more generous for older people.
Are there other changes Republicans want to make?
Because Republicans chose a procedural route that will let them avoid a Senate filibuster, they were limited in changes they could make to Obamacare. Republicans also want to loosen the requirement that insurers cover specified benefits, such as addiction treatment, mental health and maternity benefits. They argue that would give consumers the choice of tailoring their coverage to their needs.
Republicans also want to allow insurance to be sold across state lines as a way to increase competition among insurers, although this didn’t work in some states that have tried it, in large part because of how hard it is for out-of-state insurers to build a local network of providers.
How would the GOP bill affect how many people have health insurance?
About 24 million fewer people would have health insurance in 2026 than projected under the ACA, according to the nonpartisan Congressional Budget Office's analysis of the original bill. That would increase the uninsured rate for the nonelderly population from 10% under the ACA to 19%. The change would disproportionately affect older and poorer Americans.
How would the changes affect premiums and deductibles?
Premiums for plans sold on the individual market would immediately rise, but by 2026 would be about 10% lower than expected under the ACA. That’s because insurers would be able to offer plans covering a smaller share of health care costs; the age of those buying plans would on average be lower; and the bill includes funding to help states lower premiums.
The nonpartisan Kaiser Family Foundation estimates deductibles for a typical plan would be about $1,550 higher in 2017 than it would be under the ACA.
Plans would also be harder to compare.
How would the bill affect employer-provided health insurance?
Fewer employers are expected to offer insurance because they would no longer be penalized if they don’t, and because tax credits to help people buy insurance on their own would be available to more people than they are now. Fewer workers are expected to sign up for the insurance because the bill ends the penalties for people without coverage.
The CBO did not analyze how premiums for employer-provided plans could be affected.
How much does the bill cost?
The original bill was projected to save the federal government $337 billion over 10 years. That figure is expected to drop when the recent changes are factored in. The biggest savings come from cutting Medicaid funding and reducing the subsidies for private insurance plans. Some of those savings would be offset by repealing the taxes the ACA imposed on the wealthy, on sectors of the health care industry and others; ending the penalties for individuals who don’t buy insurance and larger businesses who don’t offer it; and restoring some payments to hospitals for uncompensated care, which is expected to rise.
How does the bill affect abortion services?
Planned Parenthood could not receive Medicaid or other federal funding for a year. That would reduce services to help women avert pregnancies, particularly in areas without other options for the poor, according to CBO. The number of births covered by Medicaid would increase.
Was there another provision related to abortion?
The original GOP bill allowed people who qualified for more tax credits than they needed to buy insurance to put the remainder into a health savings account. That was changed to alleviate concerns by some conservatives that the money could eventually be tapped to pay for abortion services.
What interest groups support the bill?
Business and tax groups expressing support include the U.S. Chamber of Commerce, National Retail Federation, National Federation of Independent Business and Americans for Tax Reform. The National Right to Life Committee also backs the bill.
What interest groups oppose the bill?
Major medical groups who have come out against it include the American Medical Association and the American Hospital Association. AARP and some labor unions are opposed, as are some conservative groups including Heritage Action, Americans for Prosperity and the Club for Growth.
Do Republicans have enough votes to pass the bill?
That’s unclear. Despite changes made Monday, some conservatives still say it doesn’t go far enough to repeal the ACA while some moderate Republicans remain concerned too many people will lose insurance. Even if the bill passes in the House over what’s expected to be united Democratic opposition, it faces a higher hill in the Senate where Republicans can afford only two defections.
Does the public support the bill?
Polls show the public divided over both repealing the ACA and the GOP’s plan to replace it. A bare majority — 51% — oppose repeal while 45% are in favor of repeal, according to a March 6-12 survey conducted for the nonpartisan Kaiser Family Foundation.
An analysis of surveys of the GOP’s replacement bill by the website FiveThirtyEight found just 30% of voters on average favor the bill while 47% oppose it.
Would the bill meet President Trump’s promises?
Trump, in January, promised a plan that offers insurance “for everybody” that is “much less expensive and much better.” But fewer people would have coverage under the GOP bill than under Obamacare. For some, that would be their choice because they would no longer be penalized for going without. Many others, however, would be uninsured because they could not afford it. Premiums for those who buy coverage on their own would ultimately go down slightly, but that’s in part because the coverage would be skimpier — not better — than what’s available under Obamacare.
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