What The New Healthcare Bill Means For You

(SL) – By all accounts the new healthcare bill will only help the rich and deepen problems for lower income families and the elderly. CNN breaks it down nicely and The Rolling Stone made it even more blunt.

People with pre-existing conditions
Republicans have been quick to emphasize that, unlike the House bill, the Senate version preserves Obamacare’s protections for individuals with pre-existing conditions. It’s a misleading claim, though: The Senate bill still allows states to apply for waivers so they don’t have to cover the essential health benefits they were forced to cover under the Affordable Care Act – which, in practice, makes it possible for insurance companies to refuse to cover some treatments for individuals with certain health histories. The outcome is exactly the same.

Poor people
Senate Republicans’ bill would offer Americans less money to help pay for worse health care plans. The bill drastically alters the structure under which the subsidies poor people used to pay for health insurance are determined. As Vox’s Ezra Klein explains, under Obamacare’s “benchmark” or average plan, insurers had to cover at least 70 percent of health care costs. Under the Republicans’ benchmark, insurers would be responsible for only 58 percent – that’s 2 percent less than the ACA’s barest-bones plan. The Senate plan also “increases the percentage of your income you can pay for a benchmark plan before it’s deemed unaffordable and additional subsidies kick in.”

That’s not all. The new bill phases out the extremely popular expansion of Medicaid that Obamacare initiated and, even more insidiously, as Democratic Sen. Dianne Feinstein pointed out on Twitter, “It ends Medicaid as we’ve known it since 1965.” The plan also imposes caps on Medicare spending, something the program has never had. A spending limit would mean less money to cover the needs of enrollees, two-thirds of whom are poorer, younger families with children.

Old people
Right now, Medicaid provides insurance for some 4.6 million low-income seniors, but that number is expected to increase as Baby Boomers age. The bill’s proposed caps on Medicaid spending include annual increases pegged to inflation, and those increases don’t account for the increase of older enrollees or the fact that those enrollees will come with much higher health care costs, as AARP recently pointed out. Under the House bill, insurance subsidies were pegged to age – an ill-conceived proposition that would have increased premiums the most for the oldest, poorest Americans. Under the Senate bill, subsidies are pegged to income, age and location, which means that older Americans will still see dramatic increases in their premiums.

Women
Not only does the new Senate bill end federal funding for Planned Parenthood, an organization that provides everything from mammograms and cervical cancer screenings to STI testing and contraceptives to 2.4 million women and men every year – it also adds pregnant women to the list of individuals who are ineligible for Medicaid. The impact of this change can’t be overstated. According to the nonpartisan Kaiser Family Foundation, more than half of all births in 24 states are financed by Medicaid.

With all of those people losing, you may be wondering: Who, exactly, “wins” under the new bill?

Easy: health insurance companies and the rich. The new bill eliminates taxes created under the ACA that helped pay for the subsidies for poorer American. Specifically, the Republican bill would repeal the 3.8 percent tax on investment income and the 0.9 percent tax on annual income for households making over $250,000. For the ultra-wealthy – that 0.1 percent of the population netting more than $3.7 million a year – that amounts to an average tax cut of $165,000, according to the nonpartisan Tax Policy Center. The bill also ends taxes imposed on tanning salons and pharmaceutical companies, and repeals an existing rule banning health insurance companies from deducting more than $500,000 in CEO pay.

People under 26

Affordable Care Act (Obamacare)

Can get insurance through a parent’s plan or buy independently.

House Bill: American Health Care Act

Stays the same.

Senate Draft: Better Care Reconciliation Act

Stays the same.

Adults under 65

Affordable Care Act (Obamacare)

Can buy insurance on health exchanges, with tax credits and subsidies if they meet income requirements up to 400 percent of poverty level. Cost of insurance is based on tobacco use and age, with the people nearing 65 paying no more than three times what the youngest pay. Premiums can’t cost more than 9.5 percent of income. Those with very low or no income qualify for Medicaid.

House Bill: American Health Care Act

Will see tax credits to pay premiums based on age, not income, and that max out at $4,000, much less than under the ACA. The oldest people under 65 can be charged five times more than the youngest, and maybe more depending on state rules. Medicaid cut after 2020.

Senate Draft: Better Care Reconciliation Act

The oldest people under 65 would pay five times more than young people. Subsidies to help pay for insurance would end at incomes of 350 percent of poverty level, with adults 59-64 paying up to 16.2 percent of income. Medicaid would be cut starting in 2021.

Low-income nursing home residents

Affordable Care Act (Obamacare)

Skilled nursing care covered by Medicare up to 100 days. Medicaid is available based on income.

House Bill: American Health Care Act

Skilled nursing care covered by Medicare up to 100 days. Medicaid services could be cut as states see federal funding decline.

Senate Draft: Better Care Reconciliation Act

Skilled nursing care covered by Medicare up to 100 days. Medicaid coverage for long-term care could be cut as federal payments to states decline.

People with preexisting medical conditions

Affordable Care Act (Obamacare)

Coverage cannot be denied or cost more.

House Bill: American Health Care Act

States can get permission to let insurers charge more for some preexisting conditions, and to exclude some people altogether. States would have access to federal money to help those with expensive policies or conditions.

Senate Draft: Better Care Reconciliation Act

Insurance companies would be required to accept all applicants regardless of health status. But the draft bill would let states ask permission to reduce required coverage, also called “essential health benefits,” which would give insurers some discretion over what they offer in their plans, and possibly change what they can charge consumers.

People who go to Planned Parenthood

Affordable Care Act (Obamacare)

Federal programs reimburse for most Planned Parenthood services.

House Bill: American Health Care Act

A one-year block will be placed on federal reimbursements for care provided by Planned Parenthood.

Senate Draft: Better Care Reconciliation Act

A one-year block will be placed on federal reimbursements for care provided by Planned Parenthood.

People with disabilities

The majority of Medicaid dollars go to people with disabilities.

Affordable Care Act (Obamacare)

May qualify for Medicare and also Medicaid.

House Bill: American Health Care Act

Services covered by Medicaid could be cut as federal funding to states declines over time.

Senate Draft: Better Care Reconciliation Act

Services covered by Medicaid could be cut as federal funding to states declines over time. The cuts would be larger than those in the House bill.

People who use mental health services

Affordable Care Act (Obamacare)

Covered by all plans under essential health benefits.

House Bill: American Health Care Act

Could lose coverage in states that get waivers from covering essential health benefits.

Senate Draft: Better Care Reconciliation Act

Medicaid would not be required to cover mental health after 2019. For other types of insurance, requirements could change in states that request a waiver.

Working poor on Medicaid

Affordable Care Act (Obamacare)

Thirty-one states and the District of Columbia offer expanded Medicaid coverage.

House Bill: American Health Care Act

Federal funding for Medicaid expansion phases out, potentially affecting millions of people who are currently enrolled under the expansion.

Senate Draft: Better Care Reconciliation Act

Federal funding for Medicaid expansion phases out between 2021-2023. In addition, eight states would have a trigger clause — if the federal matching rate declines below the ACA-promised rates, the expansion goes away immediately. That would affect Arkansas, Illinois, Indiana, Michigan, Montana, New Hampshire, New Mexico, and Washington. Further reductions would start in 2025.

The wealthy

Affordable Care Act (Obamacare)

Pay extra taxes to support ACA.

House Bill: American Health Care Act

Ends ACA taxes on corporations and cuts taxes for the wealthy by about $592 billion.

Senate Draft: Better Care Reconciliation Act

Similar to the House bill; would repeal ACA taxes on corporations and the wealthy that pay for insurance subsidies.

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