House Republicans finalized their a health-care reform bill, about a month after they had to pull a similar bill from consideration for lack of support. The latest version of the American Health Care Act was opposed by all 193 Democrats opposed the bill and 20 Republicans — primarily moderates who thought the legislation rolls back health-care benefits too much.
[New: How the House voted to pass the Obamacare replacement]
The latest round of changes is aimed at giving states more control over ACA regulations. States could choose to allow insurers to charge customers different amounts based on their preexisting conditions and offer much skimpier plans, among other things.
The most recent change, released on Wednesday and designed to attract moderates, allocates $8 billion of federal funding toward helping people with pre-existing conditions afford their premiums.
See those and other changes the Republicans proposed to the ACA below:
Who would be covered
Under House Republicans’ plan, the government would no longer penalize Americans for failing to have health insurance, but insurance companies could.
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End enforcement of the individual mandate requiring coverage.
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Changed in latest plan
Insurers would be allowed to impose a 30 percent premium surcharge on consumers who purchase a new plan after letting their previous coverage lapse — incentivizing healthy people to remain insured. States could choose to make this penalty more severe.
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Eliminate the employer mandate on larger companies to offer affordable coverage.
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Nothing is added.
How they would pay for coverage
The federal health insurance subsidies that help most people with ACA marketplace plans afford their coverage would change. Health care would get substantially less affordable for most of these people, especially those who are poor, unhealthy or old, according to Linda Blumberg of the Urban Institute, Christine Eibner of the RAND Corporation and Karen Pollitz of the Kaiser Family Foundation.
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ACA tax credits based on income, age, geography and other factors, which benefited lower- and moderate-income people buying coverage through ACA marketplaces.
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New tax credits would be based on income and age for people buying any individual health insurance plan sold in their state. The amount would not increase when premiums increased.
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Cost-sharing subsidies, which were provided to insurers to help their ACA customers cover deductibles and copayments, would end in 2020.
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Nothing is added.
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Insurance companies are not allowed to increase someone’s premiums or deny coverage based on preexisting conditions.
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Changed in latest plan
States could allow insurers to increase someone’s premiums based on their preexisting conditions if they had a break in coverage. The state would have to set up some other program, like a high risk pool, to cover their sickest residents. And the federal government would have its own $8 billion fund to help cover sick people’s high premiums within the individual market.
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Insurers can charge older customers up to three times more than they charge younger customers.
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Changed in latest plan
Insurers would be able to charge older customers up to five times more than they charge younger customers. Under the latest amendment, states could change this ratio, though it’s unclear whether it could be higher than 5-to-1.
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Individuals can contribute up to $3,400 and families up to $6,750 to pre-tax health savings accounts.
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Starting in 2018, individuals could contribute up to $6,550 and families could contribute up to $13,100 to pre-tax health savings accounts.
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Nothing is removed.
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States would receive $130 billion over 10 years through a new Patient and State Stability Fund for high-risk pools and other programs to help sicker people.
Proposed changes to Medicaid
The bill would restructure Medicaid, narrow the program’s eligibility and likely decrease its funding.
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Medicaid is currently an entitlement program with open-ended, matching federal funds for anyone who qualifies.
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Medicaid would be funded by giving states a per-capita amount or block grant based on how much each state is currently spending, not adjusting for rising costs. Overall, this is expected to substantially decrease federal funding, according to the Congressional Budget Office’s report on the plan.
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States would not be able to expand Medicaid after this year. In those states that do expand by the deadline, the federal government will pay a smaller portion of the cost for people who sign up after 2019, making the expansion much more expensive for those states.
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Nothing is added.
Other key elements of the plans
The legislation would preserve some of the most popular features of the 2010 health-care law, while allowing states to opt out of others.
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Insurers were required to cover certain categories of essential health benefits, such as hospital visits and mental health care.
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States would be allowed to change what qualifies as an essential health benefit.
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Caps on annual or lifetime coverage were banned for essential health benefits.
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The ban on caps itself is not changing, but because states could narrow what qualifies as an essential health benefit, more types of care could face caps.
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Planned Parenthood is eligible for Medicaid reimbursements or federal family-planning grant, but federal money cannot fund abortions.
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Planned Parenthood would face a one-year federal funding freeze.
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Dependents would still be able to stay on parents’ insurance plans until age 26.
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