Republican route limits extent of ACA changes
Younger people stand to benefit more than older in bill the House will take up
The House of Representatives was scheduled to vote Thursday on the Republican plan to replace the Affordable Care Act. Here is a look at the impact of that legislation:
Q: How would the bill change Obamacare?
A: 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 receive less money for their Medicaid programs, although they could gain 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. People who are younger, higherincome 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. The subsidies that help pay for deductibles and copayments 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.
Q: What parts of Obamacare would not be changed?
A: 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.
Q: What changes were recently made to the bill?
A: 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.
Q: Are there other changes Republicans want to make?
A: 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 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-ofstate insurers to build a local network of providers.
Q: How would the GOP bill affect how many people have health insurance?
A: About 24 million fewer people would have health insurance in 2026 than projected under the ACA, according to the non-partisan Congressional Budget Office’s analysis of the original bill. That would increase the uninsured rate for the non-elderly population from 10% under the ACA to 19%. The change would dispro- portionately affect older and poorer Americans.
Q: How would the changes affect premiums and deductibles?
A: Premiums for plans sold on the individual market would immediately rise, but by 2026, they 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 non-partisan Kaiser Family Foundation estimates deductibles for a typical plan would be about $1,550 higher in 2017 than it would be under the ACA.
Q: How would the bill affect employer-provided health insurance?
A: Fewer employers would be likely to offer insurance because they would no longer be penalized if they didn’t and because tax credits to help people buy insurance on their own would be available to more people. Fewer workers would be likely to sign up for the insurance because the bill would end the penalties for people without coverage.
Q: How would the bill affect abortion services?
A: Planned Parenthood could not receive Medicaid or other federal funding for a year. That would reduce services to help women avert pregnancies.