The
American Health Care Act, which narrowly won passage in the House on
Thursday, could transform the nation’s health insurance system and
create a new slate of winners and losers.
Here's an article from the NEW YORK TIMES outlining who benefits and who suffers...
While
the Senate will probably demand changes, this bill, if it becomes law
in its current form, will repeal and replace large portions of the
Affordable Care Act (Obamacare). It will change the rules and subsidies
for people who buy their own insurance coverage, and make major cuts to
the Medicaid program, which funds care for the poor and disabled.
Any
sizable change in our complex health care system leaves some people and
businesses better or worse off. For some, insurance will become more
affordable — or their taxes will be lower. Others will lose out on
financial support or health care coverage. You can see how you might be
affected in our summary of winners and losers.
Losers
Poor people:
Many states would be expected to roll back their expansions of the
Medicaid program to cover childless adults without disabilities. The
bill would also substantially reduce subsidies available for Americans
just over the poverty line, the group that benefited most from
Obamacare’s subsidies. Poor Americans are much more likely to become
uninsured under the bill, according to the Congressional Budget Office, and those who retained coverage would pay much more of their limited incomes on premiums and deductibles.
Older Americans, in most states: The same factors that make the bill better for many young Americans make it worse for those who are older.
Insurance companies could charge a 64-year-old customer five times the
price charged to an 18-year-old one, to cite the most extreme example.
The changes in the subsidy formula would also require older middle-class
Americans to pay a much larger share of their health insurance bill.
The Congressional Budget Office estimates that far fewer older Americans
would have insurance coverage under this bill than under the Affordable
Care Act.
Who Wins and Who Loses Under Republicans’ Health Care Plan
Maps comparing tax credits under the Affordable Care act
and those in the plan House Republicans recently released across groups
of incomes and ages.
People with pre-existing health conditions, particularly in some states. The bill allows states to waive rules on minimum benefit standards and rules that prohibit insurance companies from charging higher prices to customers with a history of serious illness — or even minor diseases. And it could mean their insurance covers fewer medical services.
The benefit changes could also affect Medicaid beneficiaries, and they
could mean cutbacks on coverage for mental health and drug addiction
treatment. States that waive the rule about prices would be required to
set up a program for high-risk customers, and would get some federal
funding to do so, but the details are unclear.
State governments: The bill cuts back substantially on federal funding for state Medicaid programs,
while offering states only limited new flexibility in how they manage
them. Over time, the changes are likely to shift an increasing share of
Medicaid costs onto states.
Hospitals: Assessing an earlier version of the bill, the Congressional Budget Office estimated that some 24 million fewer people
would have health insurance in a decade. Some of those people would
still have medical emergencies and require hospital care. Obamacare made
substantial cuts in how much Medicare pays hospitals, on the theory
that they would make up the difference with more paying customers. The
Republican bill does not restore any of the Medicare cuts. Hospitals in
poor communities where a lot of people signed up for Medicaid would
probably experience the biggest hit.
Planned Parenthood: The
bill would prevent Planned Parenthood from receiving any federal money
for one year, a major hit for a health care provider that relies
substantially on payments from Medicaid and the Title X family planning
grant to provide contraception, cancer screenings and other women’s
health services. The bill would also seek to reduce access to abortions,
by preventing federal subsidies from going to any health plan that
covers abortions.
Winners
High-income earners:
The bill eliminates two taxes on individuals earning more than $200,000
or couples earning more than $250,000: a 0.9 percent increase on the
Medicare payroll tax, and a 3.8 percent tax on investment income. It
also allows people to save more money in tax-excluded health savings
accounts, a change most useful to people with enough money to have savings.
Upper-middle-class people without pre-existing health conditions:
The Affordable Care Act cut off subsidies to help people buy their
insurance at an income of around $48,000 for a single person. The
American Health Care Act would let people get government subsidies much higher up the income scale
— up to about $150,000. But the bill allows states to waive rules on
minimum benefit standards and rules that prevent insurance companies
from charging higher prices to customers with pre-existing illnesses.
That means, over all, the gap between the tax subsidies and the cost of
needed care could widen, even for some people who will get extra
financial help.
Young, middle-class people without pre-existing health conditions:
The bill would change how insurance companies price their products in a
way that would lower prices for young customers. It also gives them a
flat subsidy that is, in many cases, higher than what they would receive
under Obamacare. There is some variation by region, and people with pre-existing conditions could be charged higher prices in some states.
People who wish to go without insurance:
The bill would eliminate the individual mandate, which charges a tax
penalty to Americans who can afford insurance but do not obtain it.
People who want less comprehensive health coverage:
The bill allows insurers to offer health plans with higher deductibles
and co-payments, a change likely to lower premiums. Customers in states
that waive benefit rules may also be able to buy plans not covering as
many medical services, like maternity coverage.
Large employers:
The bill eliminates Obamacare’s employer mandate, which required large
employers to offer affordable coverage to their workers. If the bill
becomes law, companies that do not wish to cover their workers will face
no penalty. It frees all large employers of the complex reporting
necessary to enforce the provision. It also pushes back enactment of a
tax on high-cost employer health plans.
Medical device companies, indoor tanning companies and a few other medical industries: The bill rolls back taxes on devices, tanning,
prescription drugs and health insurance products. Some of those
industries may lose a little as well — insurance companies, for example,
may have fewer paying customers.
