What would stay and what would go in the House Republican plan to roll back Obamacare

Don Humbertson, a 64-year-old lung cancer survivor, is examined by Dr. Wade Harvey at a community health center in Blacksville, W.Va.

March 23, 2017 3 AM PT

Reporting from Washington —

House Republicans are scheduled to vote Thursday on legislation that would roll back substantial parts of the Affordable Care Act, often called Obamacare.

If the bill passes the House, it must still go through the Senate, where many changes are expected to be made. But if the American Heath Care Act were to become law, it would mean big changes for millions of Americans.

Here is a rundown of what would change and what wouldn’t under the House plan.

A side-by-side comparison of Obamacare and the GOP’s replacement plan »

What would change:

Health insurance mandate

This unpopular provision of Obamacare, which requires Americans to have health insurance or pay a tax penalty, is on the way out. Under the House bill, the government would no longer penalize people for being uninsured.

In place of the insurance mandate, though, the bill would force insurers to charge a 30% penalty on consumers who tried to buy a health plan after going without insurance for more than two months.

Medicaid

Obamacare provided hundreds of billions of dollars to states to help them expand their Medicaid programs to cover poor, childless adults, a population that has not historically had access to Medicaid.

The House bill rolls back federal aid for the expansion. It also would cap future federal funding for Medicaid.

Those changes together are estimated to cut nearly $1 trillion in federal Medicaid spending, an unprecedented retrenchment that is expected to cause the number of Americans without health coverage to soar.

Insurance marketplaces

The Obamacare marketplaces, such as HealthCare.gov, enable people who don’t get health benefits at work to compare plans, just as they might compare hotel rooms or airline tickets online.

Low- and moderate-income shoppers on the marketplaces can get insurance subsidies to help offset their premiums, assistance that about 8 million Americans currently get.

The House plan completely scraps Obamacare’s subsidy system and scales back assistance.

Most importantly, lower-income Americans who make too much to qualify for Medicaid and consumers who live in areas of the country with very high insurance costs will no longer get extra aid, as they do under the current law. That is expected to dramatically raise premiums for many older, low-income Americans.

Taxes

The current law includes a mix of taxes to offset the cost of subsidizing insurance for tens of millions of low- and moderate-income Americans.

These include taxes on insurance companies and medical device makers and new higher income taxpayers (individuals making more than $200,000 and couples making more than $250,000).

Those taxes are gone in the House bill, which translates into some pretty large tax cuts, particularly for the wealthiest Americans.

What won’t change (for now):

Guaranteed coverage

Obamacare included a revolutionary guarantee that allows Americans to get health insurance even if they’re sick. That put an end to insurers denying coverage to people who had preexisting medical conditions.

The House bill preserves the guarantee although other consumer protections contained in the law may be repealed.

Medicare

Obamacare made relatively minor changes to the popular health plan for the elderly and disabled, though it did expand coverage of prescription drugs. That’s been popular with seniors.

The House GOP plan would preserve the expanded drug coverage.