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

Under the GOP proposal

  • The House GOP plan would not explicitly eliminate guaranteed coverage but would allow states to seek waivers from several consumer protections
  • States would be allowed to scale back benefits that insurers must cover. Because of the way the law is structured, that could allow insurers to reimpose annual and lifetime limits on some coverage.
  • States would also be able to allow insurers to charge sick people more, potentially making coverage unaffordable for some
  • Insurers would be able to charge older consumers five 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

Under the GOP proposal

  • It is unclear how the marketplaces would work because insurers might potentially offer health plans that do not offer the same set of benefits

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 Affordable Care Act

  • People using healthcare marketplaces and making less than $48,000 a year receive subsidies to help them buy insurance
  • The amount of the subsidy is tied to a person’s income and to the cost of insurance in the person’s area
  • The subsidies are automatically applied to the consumers’ monthly insurance bills rather than having to wait for a rebate

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 Affordable Care Act

  • A person is required to purchase health insurance or pay a tax penalty

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

Under the GOP proposal

  • Insurance companies would still be banned from charging women more
  • States could seek waivers to allow insurers to drop some basic benefits, such as maternity care and contraceptives
  • Medicaid would no longer have to offer these benefits, which would impact low-income women. Nearly 80% of Planned Parenthood patients have incomes at or below 150% of the federal poverty level
  • Medicaid would be barred from providing funding for any health clinics that provide abortion services, including Planned Parenthood
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 Affordable Care Act

  • The federal government and states share the cost of insuring the poor. The amount of money that Washington gives each state varies depending on how much medical care that state’s Medicaid patients receive
  • The federal government is picking up almost the entire cost of expanding Medicaid coverage to low-income adults without children in the 30 states (and the District of Columbia) that have chosen to expand their programs

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

States that adopted medicaid expansion

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

Under the GOP proposal

  • Medical device makers, insurance companies and wealthy Americans would all receive a big tax cut as these taxes are eliminated
  • The tax cuts total about $600 billion over the next decade.

Sources: Census, Medicaid.gov, Kaiser Family Foundation, Congressional Budget Office, Planned Parenthood, Times reporting

Credits: Additional reporting and production contributions by Joe Fox

LA Times 5.4.2017

Leave a Reply

Your email address will not be published.