Where Senate health bill will affect Americans most

Senate Republican leaders unveiled their healthcare bill Thursday, after weeks of crafting it behind closed doors. The bill, like the House’s, makes steep spending cuts to Medicaid and insurance subsidies, and uses the savings to fund a substantial tax cut for the health care industry and wealthier Americans.

The subsidy cuts fall disproportionately on lower-income and older Americans. Those who live in rural areas, where health care costs tend to be higher, also stand to pay higher premiums, especially in the House bill, according to two analyses by the Kaiser Family Foundation.

The Senate bill cuts subsidies for low-income Americans, but not as much as the House bill.

Under the ACA, the subsidies go to people making under 400 percent of the poverty line — about $42,000 for an individual or $98,400 for a family of four — with more money going to people who are lower-income, older or living in higher-cost areas.

The Senate bill keeps this overall structure, but by adjusting subsidy numbers and implementing policies that are projected to increase premiums, low-income people by and large end up with higher health care costs.

Compared to the Senate bill, the House bill upends the ACA’s structure entirely, basing subsidies primarily on age, rather than age, income and geography. That means some higher-income Americans would get subsidies under their plan. Under the Senate bill, higher-income people would continue to not receive subsidies.

Both the Senate and House bills drastically increase costs for older Americans.

Both bills include changes that would mean older people pay more and younger people pay less — making both groups’ premiums more reflective of their actual health care costs. The bills allow insurers to charge older people five times more than younger people (as opposed to three times under the ACA).

On top of that, both bills cut older Americans’ subsidies, in many places by more than two-thirds. The House’s cuts are generally steeper.

Under these bills, younger people’s costs would tend to go down. Because insurers would have more leeway to increase charges for older people, younger people’s premiums tend to drop.

In the Senate bill, younger people’s subsidies tend to decrease, but by less than their premiums decrease. In the House bill, many younger people’s premiums rise.