In a scramble to garner enough votes for passage, House Republicans have added more revisions, highlighted below, to their bill to repeal the Affordable Care Act (also known as Obamacare), more than a month after pulling their initial bill from the floor.
Here’s a look at how the Republican bill compares with the Affordable Care Act.
Under the Affordable Care Act
House Republican bill
Individual mandate
Repeal
Requires people who can afford it to obtain health insurance.
Penalties for going without insurance would disappear. Instead, people who have been uninsured for more than 63 days would pay a 30 percent surcharge on their premiums, an incentive designed to encourage people to maintain insurance coverage.
Employer mandate
Repeal
Requires larger companies to provide affordable insurance to their employees.
Subsidies for out-of-pocket expenses
Repeal
Tax credits to help some people pay deductibles and make co-payments.
Would repeal this in 2020.
Taxes
Repeal
New taxes on high incomes, prescription drugs, medical devices and indoor tanning.
Would roll back tax increases, which had been imposed under the Affordable Care Act to help pay for coverage expansion.
Medicaid expansion
Change
More than 30 states expanded coverage by raising the eligibility cutoff to 138 percent of the poverty level.
Would let states keep Medicaid expansion and allow states that expanded Medicaid to continue getting federal funding as they would have under the A.C.A., until 2020.
Federal funding for people who became newly eligible starting in 2020 or who left the program and came back, however, would be reduced. States that have not expanded Medicaid already would not be allowed to do so in the future.
The bill allows states to impose work requirements for some Medicaid beneficiaries. It proposes capping federal funding per enrollee, based on how much each state was spending in 2016. States also have the option to receive a lump-sum block grant.
Pre-existing conditions policy
Change
Requires insurers to cover people regardless of pre-existing medical conditions and bars them from setting prices based on a customer’s health history.
Allows states to waive the rule restricting price differences based on health. Insurers would be allowed to charge higher prices to sick customers who had experienced a lapse in coverage of more than 63 days, as long as the state also set up a program to help high-risk patients obtain insurance.
Adds $8 billion over five years to help people with pre-existing medical conditions in an effort to satisfy Republicans who voiced concern about the effects of the waivers.
Essential health benefits
Change
Basic set of benefits, including maternity care, emergency services and preventive services, that all insurers must offer.
Allows states to waive the benefit rules and set up their own standards.
Restrictions on charging more for older Americans
Change
Allows plans to charge their oldest customers only three times the prices charged to the youngest ones.
Would allow insurers to charge older customers five times as much as younger ones. But states could waive that rule and establish an even higher ratio.
Premium subsidies
Change
Tax credits to middle-income Americans to help offset the cost of premiums.
Would change the way subsidies are distributed by using age, instead of income and location, as a way to calculate how much people receive, with a cap for higher earners.
Health savings account
Change
In 2017, an individual can put $3,400 and a family $6,750 into a tax-free health savings account.
Would allow people to put substantially more money into their health savings accounts and let spouses make additional contributions.
Dependent coverage until 26
Keep
Allows children to stay on their parents’ insurance policies until age 26.
Prohibitions on annual and lifetime limits
Keep
Bars insurers from setting a limit on how much they have to pay to cover someone.
In states that waive the “essential health benefits” rules, caps on coverage could become possible on certain types of care.
Individual mandate
Under the Affordable Care Act
Requires people who can afford it to obtain health insurance.
House Republican bill
Repeal
Penalties for going without insurance would disappear. Instead, people who have been uninsured for more than 63 days would pay a 30 percent surcharge on their premiums, an incentive designed to encourage people to maintain insurance coverage.
Employer mandate
Under the Affordable Care Act
Requires larger companies to provide affordable insurance to their employees.
House Republican bill
Repeal
Subsidies for out-of-pocket expenses
Under the Affordable Care Act
Tax credits to help some people pay deductibles and make co-payments.
House Republican bill
Repeal
Would repeal this in 2020.
Taxes
Under the Affordable Care Act
New taxes on high incomes, prescription drugs, medical devices and indoor tanning.
House Republican bill
Repeal
Would roll back tax increases, which had been imposed under the Affordable Care Act to help pay for coverage expansion.
Medicaid expansion
Under the Affordable Care Act
More than 30 states expanded coverage by raising the eligibility cutoff to 138 percent of the poverty level.
House Republican bill
Change
Would let states keep Medicaid expansion and allow states that expanded Medicaid to continue getting federal funding as they would have under the A.C.A., until 2020.
Federal funding for people who became newly eligible starting in 2020 or who left the program and came back, however, would be reduced. States that have not expanded Medicaid already would not be allowed to do so in the future.
The bill allows states to impose work requirements for some Medicaid beneficiaries. It proposes capping federal funding per enrollee, based on how much each state was spending in 2016. States also have the option to receive a lump-sum block grant.
Pre-existing conditions policy
Under the Affordable Care Act
Requires insurers to cover people regardless of pre-existing medical conditions and bars them from setting prices based on a customer’s health history.
House Republican bill
Change
Allows states to waive the rule restricting price differences based on health. Insurers would be allowed to charge higher prices to sick customers who had experienced a lapse in coverage of more than 63 days, as long as the state also set up a program to help high-risk patients obtain insurance.
Adds $8 billion over five years to help people with pre-existing medical conditions in an effort to satisfy Republicans who voiced concern about the effects of the waivers.
Essential health benefits
Under the Affordable Care Act
Basic set of benefits, including maternity care, emergency services and preventive services, that all insurers must offer.
House Republican bill
Change
Allows states to waive the benefit rules and set up their own standards.
Restrictions on charging more for older Americans
Under the Affordable Care Act
Allows plans to charge their oldest customers only three times the prices charged to the youngest ones.
House Republican bill
Change
Would allow insurers to charge older customers five times as much as younger ones. But states could waive that rule and establish an even higher ratio.
Premium subsidies
Under the Affordable Care Act
Tax credits to middle-income Americans to help offset the cost of premiums.
House Republican bill
Change
Would change the way subsidies are distributed by using age, instead of income and location, as a way to calculate how much people receive, with a cap for higher earners.
Health savings account
Under the Affordable Care Act
In 2017, an individual can put $3,400 and a family $6,750 into a tax-free health savings account.
House Republican bill
Change
Would allow people to put substantially more money into their health savings accounts and let spouses make additional contributions.
Dependent coverage until 26
Under the Affordable Care Act
Allows children to stay on their parents’ insurance policies until age 26.
House Republican bill
Keep
Prohibitions on annual and lifetime limits
Under the Affordable Care Act
Bars insurers from setting a limit on how much they have to pay to cover someone.
House Republican bill
Keep
In states that waive the “essential health benefits” rules, caps on coverage could become possible on certain types of care.