WASHINGTON (AP) — The House health care bill repeals major parts of former President Barack Obama's Affordable Care Act, or ACA, as Republicans push to scale back the federal government's role in health care.
Some elements of the Obama-era law are maintained in the House GOP legislation. For example, parents can keep young adult children on their plans until age 26. And insurers can't turn away people with pre-existing medical problems. But Republicans scrap other requirements, including essential benefits such as maternity care coverage.
How the House bill, called the American Health Care Act, compares with the ACA:
ACA: About 11 million people are covered by expanded Medicaid in the 31 states that accepted it. Nationwide, an additional 12 million buy private health insurance through government-sponsored markets that offer subsidized premiums, catering to consumers who don't have job-based coverage. The uninsured rate is below 9 percent, a historic low. But people who make too much to get subsidies — those in the solid middle class and above — have seen steep premium increases and fewer options.
House GOP: The nonpartisan Congressional Budget Office estimates that the Republican bill will result in 24 million fewer people having health insurance by 2026, compared to the ACA.
ACA: Insurers can charge their oldest customers no more than 3 times what they charge young adults. That benefits older adults more prone to illness but has made coverage costly for young people, who maybe just need a prescription for allergy medicine. ACA tax credits to help pay premiums are keyed to income and the cost of insurance in local communities. Obama's law also offers cost-sharing subsidies that help low-to-moderate income people with out-of-pocket medical expenses, cutting deductibles from several thousand dollars to several hundred.
House GOP: Insurers can charge older customers 5 times what they charge young adults, more if a state allows it. Tax credits are keyed to age, with people over 60 but still too young for Medicare getting $4,000, double what someone under 30 would get. Still, groups like AARP say the combination of higher premiums and less aid for those with modest incomes translates to an "age tax" on older adults. They're concerned that age-based tax credits may be unsuitable for areas of the country with high medical costs. They're also worried about the repeal of cost-sharing subsidies in the GOP plan.
House Republicans acknowledge there's more work to be done to improve the math for older adults, and they have taken steps in their legislation to free up additional financing that the Senate can tap for that purpose. They've also created a big market stability fund for states, and they say money from the fund can be used to provide cost-sharing subsidies if states so choose.
ACA: States that accept expanded Medicaid receive a generous federal match. The expansion covers people with incomes up to 138 percent of the federal poverty line, or about $16,640 for an individual. Most new beneficiaries are low-income adults with no children at home.
Medicaid is now the country's largest health insurance program, covering more than 70 million people. The federal-state program remains an open-ended entitlement, allowing states to draw down federal money for a portion of health costs incurred by low-income people.
House GOP: Ends the higher federal match for Medicaid expansion beneficiaries; Republicans say it makes no sense to provide more generous payments for able-bodied adults than for children or the disabled. States that already expanded Medicaid can continue to receive some enhanced federal payments, but only for "grandfathered" enrollees already covered.
Of much greater significance, the bill would overhaul the underlying framework of Medicaid, ending its open-ended federal financing. Each state would receive a limited, per-beneficiary amount based on enrollment and costs. Federal payments would be increased according to a measure of medical inflation, with higher increases for elderly, blind and disabled beneficiaries.
States would also be able to select a block grant to finance their Medicaid programs. And they could impose work requirements on able-bodied adults.
The budget office says the bill would reduce projected federal Medicaid spending by about $840 billion from 2017-2026, and roughly 14 million fewer people would be enrolled by 2026.
ESSENTIAL HEALTH BENEFITS
ACA: Requires insurers to cover "essential benefits," including outpatient care, emergency services, hospitalization, pregnancy, maternity and newborn care, mental health and substance abuse treatment, prescription drugs, rehabilitation, laboratory and diagnostic tests, preventive and wellness services, and pediatric care, including dental and vision services for kids. The benefits are considered especially important for women, since birth control and other routine services are now covered as preventive care, at no charge.
House GOP: Repeals essential benefits at the federal level, returning that responsibility to the states, where it previously resided. Republicans say they're not out to gut consumer protections, but that without federal requirements many consumers could find plans with lower premiums. For example, an older married couple might not be interested in a plan that provides maternity benefits. Doctors groups say consumers who buy limited insurance plans take a risk.