The American Health Care Act of 2017
(AHCA), also known as the Better Care Reconciliation Act of 2017 (BCRA), is the
leading proposal to "repeal and replace" the Affordable Care Act (aka
Obamacare, but we'll abbreviate it ACA) and "defund" Planned
Parenthood.
On June 22, Senate Republicans
released their
draft of health care reform. The draft
legislation, called the Better Care Reconciliation Act of 2017 (BCRA), would
replace the health care bill text proposed by House Republicans if the Senate
passes it. We'll post further information explaining the Senate's BCRA proposal
once we have it.
Our summary of the House's AHCA bill
follows, below. Update
- May 4, 2017
A new deal among the Republican
factions was reached. The changes to the AHCA, as reported
by the Rules committee, are:
· States may opt-out of providing the
ACA’s essential health benefits. (This requirement was already dropped in the
bill for Medicaid but not for the individual market.)
·
States may opt-out of requiring
premiums to be the same for all people of the same age, so while individuals
with pre-existing conditions must be offered health insurance there is no limit
on the cost of that insurance. A new $8 billion fund would help lower premiums
for these individuals.
·
States may opt-out of limiting
premium differences based on age.
·
There would be a new $15 billion
fund for risk sharing to help states lower premiums.
Our summary of the original AHCA
text follows. Update
- March 24, 2017
After a fast-paced few weeks, the
vote scheduled for March 24, 2017 was cancelled after the House Freedom Caucus,
a band of some of the most conservative members of the House, pledged in block
to oppose the AHCA because it did not go far enough to repeal the ACA.
What
would stay the same
The bill would keep intact much of
the ACA. As the Republican website readthebill.gop explains,
the AHCA would "preserve vital patient protections" created by the ACA:
·
The AHCA would keep the ACA's
requirement that dependents can stay "on their parents' plan until
they are 26."
·
The exchanges (aka
marketplaces) run by the federal government and states, which listed
individual and small business health insurance plans, would continue as under
the ACA.
·
The AHCA would also continue to
provide subsidies for premiums that are based
on income, although the formula would be
completely different and the subsidy would likely be much less for young,
low-income Americans.
·
The AHCA would keep some
Medicaid benefits for those that enroll prior to 2020 (more on that
below).
·
The AHCA would keep the
restriction that subsidies can't pay for health insurance that covers abortion.
The
individual mandate stays too, but by any other name
The AHCA even includes a penalty for
individuals who don't get coverage, referred to as the "individual
mandate" in the ACA. While the ACA imposes a roughly $700
per year penalty for not holding health
insurance, the AHCA would instead impose a surcharge
of up to 30% the next time you get insurance
after a lapse in coverage.
Depending on your premiums and how
long you go without insurance, the ACHA's penalty could be more or less than
the ACA's current penalty. In many cases, it might be about the same.
What
would be expanded
·
Contribution
limits to Health Savings Accounts (HSAs) would be increased to encourage their use. With HSAs, you can put aside
some of your income for medical expenses and not pay taxes on it. (More on
that here.)
·
Under the AHCA, federal subsidies
for paying premiums could be used to pay for insurance both from and not
from the exchanges.
·
What
would go away. Some parts of the ACA would end:
If
you're on Medicaid...
·
The ACA
expanded Medicaid eligibility in 32 states that opted in to it.
The AHCA would reverse
the eligibility expansion beginning in 2020 (anyone
enrolled by then would remain enrolled), and it would reduce federal
support for Medicaid with caps on coverage.
·
The ACA expanded required
benefits under Medicaid, such as mental
health and addiction services, which would no longer be required.
If you're
covered through your employer...
If
you're on an individual plan...
·
The ACA limited what health
insurance providers could charge in premiums. Under the AHCA, those limits
would be adjusted so that younger
people might see lower premiums and older people much higher premiums.
·
The ACA's complex cost-sharing
provisions that lowered costs for some low-income Americans would be
eliminated.
Other
changes...
·
A long list of taxes created by the
ACA to pay for its subsidies would be eliminated, but some new taxes will be
added, such as a new
tax on the value of health insurance provided by an employer.
"Defunding"
Planned Parenthood
The AHCA would also prohibit federal
funding from going to Planned Parenthood, mostly through Medicaid, for one
year.
This would pause federal
reimbursements for Planned Parenthood's reproductive health, maternal health,
and child health services --- but not its abortion services because federal
funds are already prohibited from being used for abortion.
What's
the bottom line?
How the AHCA would affect you
depends on your income, how you get your health insurance, and what kinds of
health care you need.
·
For older,
low-income Americans with health insurance from the individual market:
Premiums could increase by $3,600 for a 55-year-old earning $25,000 a year and
$8,400 for a 64-year-old earning $15,000 a year. AARP
·
For low-income Americans covered
by Medicaid, the federal cap on support would likely lead to fewer
benefits and higher out-of-pocket costs. AARP 5--18 million individuals are predicted to lose
Medicaid coverage entirely. NYTimes
·
If you are covered through your
employer, your employer would be allowed to stop providing coverage --- and
that's made more likely because tax credits and the tax advantage for
employer-provided coverage would be eliminated. But experts are split on
whether the AHCA will affect employer coverage --- and even whether the ACA
ever had any effect on employer coverage to begin with. NYTimes
·
Americans with income around
$40,000-$75,000 who purchase an individual plan may be better off because
the ACA's subsidies for low-income Americans would be spread out to income up
to $75,000. USA
Today (Unless premiums
go up too.) If your income is below
that, some of your subsidies are now going to go to other people with higher
income.
·
If you have an income of
$200,000 or more, or investment income, you can expect your tax bill to go
down --- those making $1
million or morecan expect around $50,000 less in taxes each year.
Major changes to the health
insurance market like the ACA and AHCA have far-reaching effects on federal
spending and the economy. But experts polled by The New York Times are split
on whether the AHCA will save the government or cost more because the AHCA lowers both government spending and
tax revenue.
Odds
of passage
Despite now controlling both the
legislative and executive branches, and having previously voted successfully 45
times in the House to repeal the ACA, the
Republicans' AHCA is not a done deal.
On the one hand, both the House
Energy & Commerce and Ways and Means Committees passed
their respective sections of legislation on March 9 with party line votes. On the other hand, the House
Freedom Caucus, some high profile senators like Mike Lee (R-UT) and Rand Paul
(R-KY), and industry groups like the American
Medical Association and American Hospital Association have all spoken publicly against the legislation --- some
for the reason that it does not repeal enough of Obamacare. No
Democrats will likely support it. The ACA also has
all-time high support from the American public, with support reaching 54 percent last month.
Usage
of the budget reconciliation process
The Republicans don't have the votes
to pass the AHCA the normal way. Knowing that it would be filibustered by
Senate Democrats, Republicans are using the "budget reconciliation"
process to move their bill forward. Budget reconciliation makes one bill each
year immune to a filibuster (in the Senate), and the AHCA is this year's bill.
The Democrats used budget reconciliation to enact parts of the ACA originally,
so the use of reconciliation to modify the ACA (but not repeal it) is fitting.
Reconciliation can only be used on
some types of bills that affect the federal budget, limiting the sorts of
provisions that can be included in the AHCA --- a full repeal of the ACA
wouldn't be permitted under reconciliation rules. The reconciliation process
also requires the House Budget committee to formally introduce the bill after it
goes through committee --- that's why the AHCA was revealed to the public on
March 6 as a draft at readthebill.gop and
only formally introduced as a bill in Congress on March 20.
Although there are procedural
similarities between how the ACA was enacted and what is happening now with the
AHCA, there are also significant differences. The ACA was enacted after
vigorous debate on competing and substantive policy proposals for nearly a
year, with most of the final text available for several months before it was
signed by President Obama. The AHCA is on track to going from draft to law
within a matter of weeks and with hearings occurring
when America is asleep.
For
More Information
Comments
Healthcare
costs are too high, because of excessive government subsidies and
over-regulation.. Will the insurance
companies be required to include no lifetime maximums? They should be allowed to offer all coverage options
for a price to get the premiums low for the 50% healthy. This Bill is too complicated and is too riddled with bailouts , but it does remove the job-killing aspects of Obamacare.
Norb
Leahy, Dunwoody GA Tea Party Leader
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