The House is set to vote Thursday on the latest version of Republicans’ Obamacare repeal legislation. After weeks of negotiations on the bill following the GOP’s ill-fated attempt to bring it to the floor in March, here’s a refresher on what the current version of the bill actually includes:
Medicaid expansion phaseout
More than half the insurance coverage gains under the Affordable Care Act came from Medicaid, which was expanded to include those earning up to 138% of poverty ($27,725 for a family of three). The federal government pays at least 90% of the costs for those newly eligible in states that expanded the joint federal-state health care program.
The Republican bill would phase out the expansion. States would receive the extra funding only for people who are enrolled before 2020. Once those beneficiaries leave the Medicaid rolls, the higher funding stops. States would instead get a per capita allotment for Medicaid costs.
The fundamental principle of Obamacare was a mandate for individuals to have health insurance, either through their employer or through a private provider. Anyone not having insurance would have to pay a tax.
The Republican bill repeals that mandate. However, it would keep people from jumping into the market only when they need care by allowing insurers to charge them 30% higher premiums for a year. It also replaces Obamacare’s subsidies for individuals to obtain coverage with tax credits for people who don’t get coverage through their employer.
Obamacare allowed insurers to vary premiums for the same level of coverage only by tobacco use, location and age — within limits. The premiums for a 64-year-old can’t be more than three times the premium for a 21-year-old buying the same plan.
The American Health Care Act would let insurers charge older customers five times as much. That’s intended to draw more younger — and healthier — people into the individual insurance market.
Minimum insurance standards
The Affordable Care Act established a list of “essential health benefits” that all insurance plans were required to provide — including mental health services, maternity care and emergency room visits.
The Republican bill allows states to waive those requirements, under the theory that companies can sell cheaper plans that don’t provide coverage the customer may not want or need.
One of the most popular provisions of Obamacare was a requirement that insurance companies provide coverage without regard to a customer’s pre-existing health condition, and without charging them excessive premiums. But it is an obvious loser for insurers, because those people are likely to require far more medical procedures than people who do not have pre-existing conditions.
The Republican bill now allows states to waive the limit on costs for people with pre-existing conditions, but they first have to provide evidence of some alternative process for providing assistance to people who are already sick. One of the solutions for states would be creating of “high risk pools” that basically allow states to subsidize coverage for people who are priced out of the private market. A last-minute amendment to the bill added $8 billion to help states provide this assistance.
Republicans are using the bill to cut federal funding to Planned Parenthood, long the prime target of abortion opponents.
The bill would block Planned Parenthood from receiving Medicaid reimbursement for any non-abortion services it provides to patients, like testing for sexually transmitted diseases. Instead, Speaker Paul Ryan, R-Wis, says the bill would provide $422 million to community health centers that do not provide abortions.
The bill also prohibits using tax credits to buy insurance that provides coverage for abortions.