WASHINGTON - Senate Republicans’ revised proposal to rewrite the Affordable Care Act still makes significant cuts to Medicaid funding and subsidies for low- and moderate-income people who buy private insurance.
But the latest version released Thursday retains some of the ACA’s taxes and allows insurers to offer plans that provide only partial coverage.
Here’s a look at how the bill, which the Senate could vote on next week, could affect you.
Would you get a tax cut?
The revised version keeps the taxes imposed by the ACA on investment income, on high earners. And it no longer eliminates the ACA’s limit on how much of the executive’s pay an insurance company can write off as a corporate tax deduction. The bill would still repeal other ACA taxes, including those on tanning beds, sectors of the health care industry and on high-cost employer-provided insurance plans.
Would you still receive a subsidy to reduce the cost of premiums?
You could still lose all or some of your subsidy, which is now available to people earning up to $84,650 for a family of three. That income limit would still be lowered slightly and would become less generous. But people who have tax-advantaged Health Savings Accounts can use their HSA contributions to pay for premiums, instead of just for health services and products as they can now.
Could you buy bare-bones insurance plans with the subsidy?
The bill would let anyone buy catastrophic plans, including those who qualify for subsidies. Those plans have low premiums, but high deductibles and limited benefits.
What if you need a lot of health care services?
If an insurer offers plans that meet the ACA’s requirements for minimum benefits and not charging sicker people more, theinsurer could receive funding to help cover the cost of sick customers. But it’s unclear whether the funding would be enough to keep the plans affordable. Because insurers would also be able to sell plans that don’t meet the ACA’s requirements, experts say that would segment the market into sick and healthy people. Insurance companies say that would destabilize the market and increase costs for people with pre-existing conditions.
But would insurers have to cover you if you have a pre-existing condition?
The plans that don’t meet the ACA’s requirements would not have to accept sick people, according to Larry Levitt, senior vice president at the Kaiser Family Foundation. And the bill would make it easier for states to waive requirements that insurance plans cover specific benefits, which could make it difficult for those with expensive health conditions to find affordable plans. Like the earlier version, the new bill would also still end the ACA's requirement that insurers spend a specific amount of the premiums they collect on benefits, instead of on profits, administration and other expenses
Would you still get help paying for deductibles and co-payments?
The bill would still sunset in two years cost-sharing subsidies for people who purchase insurance on an exchange. But it now includes an additional $70 billion – up from $112 billion – for states to reduce insurance costs in other ways. States would have to match the funds.
Could older people be charged more?
The bill would still eliminate the ACA's requirement that insurers can't charge older customers more than three times what younger customers pay for the same coverage. Instead, those in their 60s could be charged five times as much, or more.
Would young adults be able to stay on their parents’ plan?
The bill would not change the ACA’s rule that dependent children can stay on a parent's plan until age 26.
What happens to people on Medicaid?
If you are among the more than 14 million Americans who gained eligibility through the Affordable Care Act, you could still lose it. Enhanced federal funding for the low-income adults who became newly qualified under the ACA would be phased out, ending after 2024.
Federal support for traditional Medicaid would also still be scaled back. States, which pay a portion of the cost of Medicaid, would have to find new funding or cut the program through restricting enrollment, curbing benefits, reducing payments to health care providers or finding efficiencies.
The revised bill does include changes to the way hospitals are paid by the federal government to help cover the bills of the uninsured, which are expected to increase. And if a state has a health emergency, the extra spending needed would not count toward the state’s limit on federal Medicaid dollars.
Would you still be required to buy health insurance?
The bill still effectively removes the ACA’s requirement that most people buy insurance by eliminating the tax penalties for failing to do so. But those who have a gap in their insurance coverage have to wait six months before the can reapply.
What if you receive insurance through an employer?
The bill would still end the ACA’s penalties for larger employers who don't offer insurance to workers. The nonpartisan Congressional Budget Office has said fewer employers will offer coverage if that change is made.
What if you or a family member are struggling with addiction?
The revised bill increases funding to states for addiction services, including $45 billion instead of the $2 billion in the initial version. That’s how much GOP Sens. Rob Portman of Ohio and Shelley Moore Capito of West Virginia were seeking to help fight the opioid epidemic in their hard-hit states. But it could still fall short of what’s needed.
What would happen to coverage for abortion services?
As in the original version, insurance plans sold through the exchanges could not cover abortion services. There’s an exception for abortions performed to save the life of the mother, or to end a pregnancy that resulted from rape or incest.
What about services offered by Planned Parenthood?
The bill would also continue to block Planned Parenthood from receiving Medicaid funding for a year. The federal government already prevents Medicaid patients from receiving abortion services. But the bill would also block them from using Planned Parenthood for contraception, testing for and treatment of sexually transmitted diseases, and other services. GOP Sens. Susan Collins of Maine and Lisa Murkowski of Alaska oppose this provision.
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