Oba­macare vs. AHCA and BCRA

Modern Healthcare - - NEWS - —Mara Lee

Some of the big dif­fer­ences

be­tween the Af­ford­able Care Act, the House’s Amer­i­can Health Care Act and the Se­nate’s Bet­ter Care Rec­on­cil­i­a­tion Act are:

Med­i­caid Med­i­caid ex­pan­sion

ACA: En­hanced fed­eral match for ex­pan­sion pop­u­la­tion is 95% this year, 94% next year, 93% in 2019 and 90% in 2020 and be­yond

AHCA: Match would re­main as de­scribed in ACA un­til 2020, with the en­hanced match un­til ben­e­fi­cia­ries cy­cle out of the pro­gram.

BCRA: 90% match in 2020; 85% in 2021; 80% in 2022; 75% in 2023. No grand­fa­ther­ing. Af­ter 2023, fed­eral con­tri­bu­tion is based on gen­eral state match per­cent­age.

Med­i­caid fi­nanc­ing

Cur­rent law: States design plans, provider pay­ment lev­els and el­i­gi­bil­ity. Fed­eral match rate varies de­pend­ing on the wealth of the state, rang­ing from 50% to 73%.

AHCA: In 2020, a per capita cap that could grow by ei­ther the med­i­cal com­po­nent of the Con­sumer Price In­dex or med­i­cal CPI plus 1 per­cent­age point. The aged and dis­abled adults would be un­der the more gen­er­ous per capita cap. Each state’s base fig­ure would be based on his­toric per en­rollee spend­ing.

BCRA: Per capita cap takes ef­fect in 2020, ex­cludes chil­dren who are on dis­abil­ity. In 2025, the cap would grow at stan­dard in­fla­tion, a much lower rate than med­i­cal CPI. States could set the base rate.

In­di­vid­ual mar­ket Cost-shar­ing-re­duc­tions:

Cur­rent law: Con­tinue to be paid to insurers. AHCA: Paid in 2019 and 2020 only. BCRA: Same as the AHCA.


Cur­rent law: Avail­able to per­sons or fam­i­lies be­tween 138% and 400% of fed­eral poverty level, as long as they don’t have ac­cess to af­ford­able plans through work. Are based on age, in­come and lo­cal cost of in­sur­ance.

AHCA: Avail­able for every­one ex­cept those in­sured through work. Age­based only and more gen­er­ous than cur­rent law to younger cus­tomers.

BCRA: Avail­able to those be­low 350% of poverty. Based on age, in­come and lo­cal cost of in­sur­ance. Those age 50 and older, start­ing at 200% of poverty, re­ceive lower sub­si­dies than un­der the ACA; 60- to 64-year-olds could have to spend as much as 16% of their in­come on pre­mi­ums be­fore sub­si­dies, com­pared to 9.7% in the ACA.

Es­sen­tial health ben­e­fits, med­i­cal un­der­writ­ing, pre-ex­ist­ing con­di­tions

Cur­rent law: 10 es­sen­tial health ben­e­fits, such as pre­scrip­tion drugs, ma­ter­nity care and men­tal health care are man­dated. Plans must sell to every­one and can­not charge sick peo­ple more.

AHCA: States may ap­ply for waivers to drop es­sen­tial ben­e­fits or the rules on charg­ing sick peo­ple more, but those changes only ap­ply to those who did not main­tain con­tin­u­ous cov­er­age.

BCRA: States may ap­ply for waivers, but not for re­ject­ing sick ap­pli­cants or charg­ing them more.

In­di­vid­ual and em­ployer man­dates

Cur­rent law: Every­one must have in­sur­ance or face a tax penalty. Com­pa­nies with at least 50 em­ploy­ers are re­quired to of­fer in­sur­ance.

AHCA: Those who don’t buy in­sur­ance can be charged 30% more per month for one year when they try to come back in. No em­ployer man­date.

BCRA: No man­dates.


Cur­rent law: Taxes on insurers, hos­pi­tals, med­i­cal-de­vice man­u­fac­tur­ers, rich em­ployer-based plans and in­vest­ment in­come, among oth­ers, help pay for the ex­pan­sion. Some of those taxes, es­pe­cially the Cadil­lac tax on rich em­ployer plans, were so un­pop­u­lar they were never im­ple­mented. The in­vest­ment in­come tax is the big­gest fun­der.

AHCA: The taxes are re­pealed, though not all im­me­di­ately.

BCRA: The taxes are re­pealed, some retroac­tively, such as the in­vest­ment tax, and some in 2018 and 2023. The Cadil­lac tax is tem­po­rar­ily re­pealed, but re­turns in 2026.

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