DemDaily: The House Passes Healthcare: Now What?
May 8, 2017
Last Thursday, May 4th, the US House of Representatives voted 217 to 213 (all Dems voted against) to pass the American Health Care Act (ACHA), which would repeal key elements of President Obama's Affordable Care Act (ACA) or "ObamaCare," enacted in 2010.
Immediately following the vote President Trump bused Republican Members from the Capitol to the White House for a premature Rose Garden victory lap before the media -- ignoring the fact that the proposed legislation must now go to the US Senate for passage, considered by most to be an insurmountable challenge with the plan in its current form.
Senators from both parties have expressed public opposition to the House plan that could leave 24 million fewer people with health insurance and, at a minimum, many are holding off on a vote until the revised scoring of the legislation's cost from the Congressional Budget Office (CBO).
The US Senate will review the House plan, and likely construct their own version for passage. If the Senate passes its own bill, the House must chose to approve the Senate version or negotiate a compromise.
Below is an initial look at the comparisons between Obamacare and Trumpcare.
Under Obama's Affordable Care Act (ACA)
Under GOP/Trump's American Health Care Act (ACHA)
Substantial changes in coverage for preexisting conditions, lifetime limits and basic benefits
Americans are able to get health insurance even if they're sick. ACA put an end to insurers denying coverage to people with preexisting medical conditions
The House GOP plan would not explicitly eliminate guaranteed coverage but would allow states to seek waivers from several consumer protections
Insurers are barred from charging sick consumers more for coverage
States would also be able to allow insurers to charge sick people more, making coverage unaffordable for some
Insurers cannot impose annual or lifetime limits on coverage
|States would be allowed to scale back benefits that insurers must cover, and could allow insurers to reimpose annual and lifetime limits on some coverage.
Insurers must offer a basic set of benefits, including mental health, prescription drugs and maternity care
|As of Dec. 31, 2019, ACA rules that required qualified health plans to provide hospitalization, maternity care, mental health services and other benefits would be sunsetted at the federal level. States would have the authority to set them instead.
Insurers cannot charge older consumers more than three times that of younger consumers
|Insurers would be able to charge older consumers five times more than younger consumers
The insurance marketplace would be intact, but could changed dramatically.
The Obamacare marketplaces, such as HealthCare.gov, enable people who don't get health benefits at work to compare available plans.
It is unclear how the marketplaces would work because insurers might potentially offer health plans that do not offer the same set of benefits
|All plans on the marketplaces must offer a basic set of benefits, such as hospital care, mental health services and prescription drugs
|Over 20 million (3/2016) Americans have been covered under the ACA's coverage provisions -- between Medicaid, the Marketplace, and children staying on their parents plan since 2010.
Per the CBO: The original GOP version of ACHA would remove health coverage for an estimated 24 million Americans by 2026.
Hardest hit: lower-income Americans and those nearing retirement.
Current Version:Pending CBO update
|IMPACT ON DEFICIT
Per the CBO: the original version of ACHA would reduce the deficit by $337 billion over the next 10 years -- primarily from reductions to Medicaid and the elimination of the ACA's. The current GOP version would likely shrink that substantially. (pending updated CBO analysis).
CHANGES IN INSURANCE SUBSIDIES
People using healthcare marketplaces and making less than $48,000 a year receive subsidies to help them buy insurance.
People would still receive subsidies, which phase out at incomes of $75,000 per year.
|The amount of the subsidy is tied to a person's income and to the cost of insurance in the person's area.
|The subsidy amount is tied to a person's age, not income, so low-income people would get less help.
|The subsidies are applied to the consumers' monthly insurance bills rather than having to wait for a rebate
|The subsidies would not vary with the cost of insurance, so people in high-cost areas would also not receive as much help.
No more mandate
|Obamacare, for the first time, required Americans to have health insurance.
|That would no longer be the case.
A person is required to purchase health insurance or pay a tax penalty
The tax penalty for not having health insurance would be dropped. But consumers could still face a penalty: Anyone who goes without insurance for more than two months would face a 30% premium surcharge when they try to buy a new plan.
Insurance companies cannot charge women more than men for the same health plan.
Insurance companies would still be banned from charging women more.
Plan would impose new restrictions on health plans with abortion coverage, and would defund Planned Parenthood. Most affected: Low-income women
|Insurers are required to provide a basic set of benefits including maternity care, pediatric care and contraceptives.
|States could seek waivers to allow insurers to drop some basic benefits, such as maternity care and contraceptives.
|Planned Parenthood receives federal funding for family planning and other medical services used by Medicaid recipients. Abortion cannot be funded with federal dollars.
Medicaid would no longer have to offer these benefits, which would impact low-income women. 80% of Planned Parenthood patients have incomes at or below 150% of the federal poverty level.
Medicaid would be barred from providing funding for health clinics that provide abortion services, including Planned Parenthood.
Expanded Medicaid coverage would cease and the funding structure would change
The federal government and states share the cost of insuring the poor. The funding Washington gives each state depends on how much medical care that state's Medicaid patients receive.
A fixed "per capita cap" or a "block grant" would replace the decades-old current system. Each state would have a fixed amount of money every year. That amount would increase annually by a percentage linked to the inflation rate.
|The federal government is incurring the cost of expanding Medicaid coverage to low-income adults without children in the 30 states (and DC) that have chosen to expand their programs.
|The additional federal funding that covered expanding Medicaid would be eliminated by 2020.
Would scrap Obamacare taxes that pay for subsidizing insurance. The GOP proposal does not include new taxes to offset the loss of revenue.
Insurance companies and medical device makers, which benefit from new customers under the law, pay more taxes.
Medical device makers, insurance companies and wealthy Americans would all receive a big tax cut as these taxes are eliminated.
|Taxpayers with incomes over $250,000 are also taxed more
|The tax cuts total about $600 billion over the next decade.
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