The most important thing to know about the Senate Republicans' new health care bill is that it looks a lot like the House Republicans' health care bill — the one that even President Trump described as "mean."
Unveiled on Thursday after being crafted by lobbyists and GOP lawmakers in secret for several weeks, the Better Care Reconciliation Act contains few surprises, which may explain why the Republican leadership hid it, after the slim victory of the unpopular House bill last month. The new measure would repeal all of the taxes associated with the Affordable Care Act, and it pays for the cuts by cutting billions from Medicaid.
The Better Care Act is expected to come up for a vote in the Senate next week, and its fate is uncertain. Some Republicans in the Senate and elsewhere have wavered on their support, expressing dismay at both some of the policy in the bill and the covert way it was crafted. Others will be upset that the bill retains much of the Affordable Care Act's structure, including the insurance exchanges.
Here are key details for you to know about the impact of the proposed legislation:
Medicaid stands to lose hundreds of billions of dollars
By reducing the eligibility level for insurance exchanges to 0 percent of the federal poverty line, states can withdraw from Medicaid and put millions of families into exchanges that are much less subsidized than they were under the Obamacare. The total amount of the cuts to Medicaid in the bill, over the next decade, are being estimated at about $800 billion.
Many people will lose insurance. How many? The Congressional Budget Office is expected to unveil its estimate next week. So who gets Medicaid? As the New York Times notes, Medicaid covers:
- 20 percent of all Americans
- 12 percent of all adults
- 49 percent of all births
- 40 percent of all poor adults
- 30 percent of adults with disabilities
- 64 percent of all nursing home residents
The rich get tax cuts
The bill repeals a number of taxes — the 3.8 percent Medicare tax on investment income, for example, which is a tax cut for high-income Americans.
Planned Parenthood and reproductive health coverage lose big-time
Health care plans that include coverage for abortion (excluding cases involving rape/incest or that threaten the life of the mother) no longer qualify for subsidies. Planned Parenthood loses Medicaid funding as a health care provider for low-income Americans, because it performs abortions.
Obamacare's mandated essential health benefits are going away
The ACA's list of required coverage features for health insurance plans — ambulances, maternity care, mental health services, etc. — would be eliminated beginning in 2020.
Deductibles may go up...
University of Michigan professor Nicholas Bagley points out that deductibles will increase by age, "with older people asked to front as much as 16.2 percent of their income for a high-deductible exchange plan."
... and subsidies definitely go down
Obamacare subsidies for health care plans for families earning 400 percent of the federal poverty line are pushed down to 350 percent in the new bill. Insurance plans are (on average) subsidized to cover 58 percent of costs, which is 2 percent below the lowest-tier (bronze) plans under the ACA.
The opioid crisis gets a $2 billion band-aid
The bill mandates that the federal government, in 2018, must give $2 billion in grants "to States to support substance use disorder treatment and recovery support services for individuals with mental or substance use disorders." The House bill (the AHCA), by comparison, provided $45 billion over 10 years.
The lifetime coverage cap makes a comeback
The Better Care Act reinstalls the lifetime coverage cap — the amount of coverage that insurers are obligated to provide over an insured person's life — which was something that Obamacare took away. It could affect 20 million people, according to the Center for American Progress, particularly young children, with costly and chronic conditions.