A side-by-side comparison of Obamacare and the GOP’s replacement plan
Here’s how the proposed Republican American Health Care Act—along with various amendments to the bill—compares to the 2010 Affordable Care Act.
Guaranteed coverage
People with preexisting conditions could see substantial changes in what kind of coverage they could receive.
Under the Affordable Care Act
- Americans are able to get health insurance even if they’re sick. This put an end to insurers denying coverage to people who have preexisting medical conditions
- Insurers are barred from charging sick consumers more for coverage
- Insurers cannot impose annual or lifetime limits on coverage
- Insurers must offer a basic set of benefits, including mental health, prescription drugs and maternity care
- Insurers cannot charge older consumers more than three times more than younger consumers
Insurance marketplaces
The insurance marketplace would be intact, but could changed dramatically.
Under the Affordable Care Act
- 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
- All plans on the marketplaces must offer a basic set of benefits, such as hospital care, mental health services and prescription drugs
More uninsured
The original version of Republican plan to replace the Affordable Care Act would remove health coverage for an estimated 24 million Americans by 2026, according to independent analysis by the Congressional Budget Office. The hardest hit in the long run would be lower-income Americans and those nearing retirement. Lawmakers from both parties rely on the nonpartisan budget office to gauge the potential impact of legislation.
It is unclear how the revised bill would change this as the Congressional Budget Office has not completed its analysis.
Number of uninsured could nearly double under GOP plan by 2026
Number of uninsured could nearly double under GOP plan by 20260204060 million2026202520242023202220212020201920182017If Obamacare is keptIf Republican plan is adopted28 million52 million
Impact on deficit
The initial version of the legislation also would reduce the deficit by $337 billion over the next 10 years largely from Medicaid reductions and the elimination of the ACA’s subsidies for nongroup health insurance, the CBO found.
But changes made in recent weeks likely would shrink that substantially. In the end it is unclear how much as the Congressional Budget Office has not completed its analysis.
Annual impact on federal deficit
2017201820192020202120222023202420252026-100-30$40 billion0
Changes in insurance subsidies
Who wins and who loses under the Republican proposal depends on a few factors. In a nutshell, the new system would provide less help to low-income people and those in high-cost areas. According to a Kaiser Family Foundation study, an American who is older, has lower income and lives in an area with higher premiums like Alaska or Arizona will lose out if the Affordable Care Act, also known as Obamacare, is replaced. An American who is younger, has higher income and lives in areas with lower premiums like Massachusetts or Washington may receive additional assistance under the replacement plan.
Change in assistance between Obamacare and the Republican plan*
27Age$20,000$30,000-$3,000+$3,000-$2,000+$2,000-$1,000+$1,000No change$40,000$50,000$75,000$100,000Annual income4060
*Older consumers who would pay more under the revised GOP plan may get additional assistance, though how much is unclear.
Under the GOP proposal
-
- People would still receive subsidies, which would phase out at incomes of $75,000 per year
- The amount would be tied to a person’s age, not income, so low-income people would get less help.
New tax credit proposal
AgeCredit0500100015002000250030003500400060+50-5940-4930-3920-29$2,000$2,500$3,000$3,500$4,000
- The subsidies would not vary with the cost of insurance, so people in high-cost areas would also not get as much help
Insurance mandate
Obamacare, for the first time, required Americans to have health insurance. That would no longer be the case.
Under the GOP proposal
- The tax penalty for not having health insurance would be dropped. But consumers would face a different sort of penalty: Anyone who goes without insurance for more than two months would face a 30% premium surcharge when they try to buy a new plan
Percent of Americans with health insurance
8090100%201620142012201020082010ACA signedinto law2010ACA signedinto law2014Bulk of ACA programgoes into effect2014Bulk of ACA programgoes into effect
Women’s health
The Republican plan would impose new restrictions on health plans with abortion coverage, and would defund Planned Parenthood. Low-income women would be among the most seriously affected.
Under the Affordable Care Act
- Insurance companies cannot charge women more than men for the same health plan
- Insurers are required to provide a basic set of benefits including maternity care, pediatric care and contraceptives.
- Planned Parenthood receives federal funding for family planning and other medical services used by Medicaid recipients. Abortion cannot be funded with federal dollars
Abortion services make up a small share of Planned Parenthood’s overall health services, according to its most recent annual report
13%Pregnancy/prenatal45%STD testing/treatment1%Other7%Cancerscreening/prevention31%Contraception3%Abortionprocedures
Federal subsidies make up the majority of Planned Parenthood’s revenue
43%27%Privatecontributions6%OtherGovernment grants/reimbursements24%Non-government
Medicaid
Expanded Medicaid coverage would cease and the funding structure would change.
Under the GOP proposal
- A fixed “per capita cap” or a “block grant” would replace the decades-old current system. Each state would have a fixed amount of money every year. That amount would increase annually by a percentage linked to the inflation rate
- The additional federal funding that covered expanding Medicaid would be eliminated by 2020
Taxes
Most of the taxes set up under Obamacare to pay for subsidizing insurance would be scrapped. The GOP proposal does not include any new tax to offset the loss of revenue.
Under the Affordable Care Act
- Insurance companies and medical device makers, which benefit from new customers under the law, pay more taxes
- Taxpayers with incomes over $250,000 are also taxed more
Sources: Census, Medicaid.gov, Kaiser Family Foundation, Congressional Budget Office, Planned Parenthood, Times reporting
Credits: Additional reporting and production contributions by Joe Fox
