14 Things to Know About the Republican Obamacare Replacement Plan

On Monday, Republicans finally unveiled their promised — and secretive — bill to reshape the Affordable Care Act. Known as the American Health Care Act, the Republican darling will likely move through Congress very quickly.

This bill contains a lot of information, but here are some of the highlights.

1. Despite what Republicans say, this bill won’t ‘repeal’ the Affordable Care Act

Instead, it’s using a process called ‘reconciliation.’ Republicans can’t repeal the ACA, but they can pick it apart by undoing key provisions.

2. The ban on pre-existing conditions remains

This is one of the most popular parts of the ACA — and Republicans know it. They retained this key component of the legislation in part because they heard from thousands of people like you who took the time to express their concerns about this provision.

3. The provision allowing young adults to remain on their parents’ insurance until age 26 will also stay

ACA fans were also extremely worried about the potential removal of this provision, fearing that young people might be unable to manage the costs of health insurance on their own.

4. It will gut Medicaid

Medicaid will be converted to a block granting format, which essentially means that the government will give states a lump sum every year, rather than using the cost-sharing program currently in effect. Block granting is vulnerable to cuts, especially since the bill also introduces per capita caps — once you use up your Medicaid benefits, that’s it.

Furthermore, the bill rolls back the Medicaid expansion, another popular part of the ACA that allowed an estimated 10.7 million people to get insurance that they couldn’t afford by other means. While it theoretically remains open until 2020, it will freeze at that point, and Republicans clearly hope that people will shift out of the program.

5. It contains numerous anti-choice provisions

Despite the fact that the Hyde Amendment already bans the use of federal funds for abortion services, the bill also cracks down on private insurance, creating a strong incentive for insurers to stop offering abortion coverage. People won’t qualify for tax credits if their plans cover abortion, for example.

Among other things, it will freeze funding to “prohibited entities,” which include health centers that provide abortion services outside the exceptions permitted by the Hyde amendment. That’s a shot across the bow at Planned Parenthood: Stop offering abortions, keep your federal funds.

Remember: Republicans insist that this is all about choice, but they’re structuring the bill in a way that dictates what kind of coverage insurance providers should and can offer — and that deprives consumers of choice.

6. The individual and employer mandates are gone

Americans are no longer required to carry minimum health coverage or face a small tax penalty. Many people may lose insurance due to the disappearance of the Medicaid expansion, and others may drop it, feeling that the expense isn’t worth it. Since they’re not paying into the system, insurance may go up to counterbalance the number of people with chronic health needs.

Meanwhile, employers are no longer required to extend coverage to their staff — a huge problem when nearly 50 percent of Americans get their health insurance through employer plans, which are often less costly because they benefit from bulk price negotiations.

7. It penalizes people who lose insurance

While people don’t have to get insurance, if they’re uninsured for 63 days and want to buy insurance, they pay a 30 percent penalty over their insurance premium. This penalty, which puts cash in the pockets of insurance companies, is pitched as an “incentive.”

8. Essential benefits will disappear under some Medicaid plans

A provision in the bill creates a “sunset clause” on the “ten essential benefits” specified by the ACA for plans purchased under the Medicaid expansion. People holding these plans wouldn’t be guaranteed access to benefits like maternity care or mental health services.

9. High-risk pools are coming back

Though they were ineffective before, it looks like high-risk insurance pools will return, with the government pledging funds for “stabilization” to the states. Historically, people who were unable to get insurance could apply to a state-administered “pool” of people in a similar position. If they qualified and lived long enough to survive the waiting list, they’d be offered a bare bones plan at a shockingly high price — sometimes in excess of $1,000 monthly.

10. Health Savings Accounts (HSAs) will be expanded

Private savings accounts like HSAs are popular with Republicans, who claim that they enhance patient choice by allowing people to save money to apply directly to health care expenses. This policy assumes, of course, that people will have money to set aside in an HSA.

11. It includes pointed attacks on immigrants

Before receiving Medicaid coverage, people will be required to provide proof of citizenship — something not even all native-born citizens can offer. This feeds the myth that undocumented people create a drain on the public health system.

12. It eliminates actuarial value

If that sounds like wonkery, let’s put it another way: Under the ACA, insurers were required to provide plans at various “metal” levels –like silver and platinum — and they had to offer standardized benefits and terms, calculated using a metric called actuarial value. If you purchased a Gold plan from Insurer A, for example, it had to be materially similar to other Gold plans on the market. This created consistency and transparency, and Republicans are repealing it — for “flexibility.”

13. It allows insurers to charge older adults more

Right now, insurers are allowed to slightly increase premiums for older adults, in a ratio determined by the ACA. Under this plan, that ratio would increase, allowing insurers to charge older adults a much higher rate than younger ones — and the tax credits they may be eligible for will increase with age, in theory to counteract this rate change. The Kaiser Family Foundation notes that older adults may actually receive a smaller tax benefit under the AHCA than they do under the ACA, though.

14. It replaces subsidies with tax credits

As alluded above, instead of using the subsidy system of the ACA, which offered incentives based on income to help people buy insurance, the AHCA uses a tax credit system, based on age, and, theoretically, income. However, low-income Americans are likely to suffer under this plan.

Photo credit: LaDawna Howard

69 comments

Marie W
Marie W6 months ago

thanks for this article.

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Philippa P
Philippa P10 months ago

Thanks.

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heather g
heather g10 months ago

Good luck to Americans....

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william Miller
william M10 months ago

thanks

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Margaret Goodman
Margaret G10 months ago

Steve F wrote, " ... This latest version of universal health coverage corrects many of the existing problems ... " What were the existing problems that Trumpcare fixes? What is your evidence that Trumpcare will give health care to all those in the United States legally?

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Dan Blossfeld
Dan Blossfeld10 months ago

Sounds like many good points that should have been there in the first place.

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anne M
anne M10 months ago

Interesting how all America is concerned with is to keep people from accessing healthcare and restrooms. What's wrong with these people?

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John B
John B10 months ago

Thanks Ms. for sharing the details. Everyone loses but the top 1 per-cent. I strongly support a Medicare for All plan and will be working hard to elect progressives like Bernie Sanders and Elizabeth Warren into office in the mid-term elections and would encourage everyone to do the same.

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Margie F
Margie F10 months ago

Good luck to America.

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Brian F
Brian F10 months ago

Criminal scumbag republicans and corporate democrats are all bought and paid for by big pharma, and our criminal healthcare industry. They want you to die if you get sick. True progressives like Bernie Sanders and the Green party's Jill Stein are blocked from having any power by our corrupt corporate owned duopoly, so we'll never have single payer universal healthcare with a public option, or Medicare for All. Obama could have pushed single payer universal healthcare and the republicans lacked the votes to block it, early in his first two years of his administration, but instead he sold out, and gave of a Romney republican plan, that still leaves the criminal healthcare industry with way to much power. Big pharma and our criminal healthcare industry own all the venal republicans and most of the democrats like Cory Booker who took $300,000 from big pharma, and refused to support a bill to lower prescription drug prices, so you can forget about ever having single payer universal healthcare like most advanced countries. America is a corporate owned kleptocracy, and their is nothing that can change it.

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