The American Health Care Act does a number of things.
- It ends Obamacare's mandate that most Americans buy health insurance or face a penalty. It would, however, allow insurers to charge people more if they have a gap in coverage.
- It would end new enrollment in Medicaid expansion on Dec. 31, 2019 for states that expanded the government health care program for the poor. Georgia is one of 19 states that chose not to expand.
- It would also fundamentally change how the federal government pays states for Medicaid. Instead of paying states a certain percentage of all of their Medicaid costs, it would allow states to opt for "block grants" that are lump sum payments and give them more flexibility in who the program would cover. Experts say such a move would almost certainly reduce enrollment and cut services.
- An amendment added to the bill after it failed to garner enough Republican support in March would allow states to opt out of two key Obamacare provisions. It would let insurers charge sicker people higher premiums. Right now, they can't. It would also let states opt out of Obamacare's mandate that insurers cover certain "essential" health benefits, such as maternity care and mental health treatment.
- It would offer tax credits, like Obamacare does, but those credits would be based on people's age rather than income. This would benefit younger, higher-income Americans and mean less financial help for poorer, older individuals.
- It would also offer tax credits to higher-income Americans who currently make too much to qualify for financial help under Obamacare.
- It would allow insurers to charge older Americans even higher premiums because of their age. Right now, they can charge older people up to three times more than younger consumers. The bill would let them charge up to five times more.
- It would continue the popular Obamacare rule that allows parents to keep kids on their insurance until age 26.
- It would provide states with a "Patient and State Stability Fund" they could use to help cover sicker, more expensive patients. Under this, states could set up high-risk pools to cover expensive patients but traditionally high-risk pools have been too expensive for states to operate.
- It would cut roughly $880 billion in taxes — mostly for wealthy Americans — instituted under Obamacare.
What would these changes mean?
Under the original version of the bill, an estimated 24 million Americans would lose their health insurance coverage by 2026, according to a report by the nonpartisan Congressional Budget Office.
The CBO, Congress’s scorekeeper, has not yet scored the bill in its latest form with the new amendments relating to pre-existing conditions and essential health benefits, and the House is expected to vote without one. The decision to let states opt out of Obamacare’s mandate that insurers can’t charge people more because of their health history would likely lead to more people losing insurance.
An estimated nearly 1.8 million people in Georgia alone have pre-existing conditions. Most of them get coverage through an employer or another source. But those who buy their own coverage on the individual market would face higher costs. The bill also now has more funding to cover higher-risk people, which could reduce the number of uninsured.
What’s happening today?
The House is expected to vote on the American Health Care Act early this afternoon before adjourning for an 11-day recess. This comes after a failed attempt to pass the bill in March when both staunch and moderate conservatives opposed it for different reasons. The hard-line Freedom Caucus argued the bill didn’t go far enough in eliminating Obamacare, while moderates feared that too many Americans would lose their health insurance under the plan.
However, it’s expected that House leaders now have the 216 yes votes they need to pass it after key changes were made.
Democrats remain vehemently opposed to the bill, arguing it helps younger, wealthier Americans at the expense of poorer, more vulnerable people who will be hurt by it and that it will cause millions of Americans to lose their coverage.
So what happens next?
If the House does indeed pass the bill this afternoon, it heads to the Senate where it will face stiff opposition from not just Democrats but also moderate conservatives. Those Republicans have the same fears their counterparts in the House faced — worrying that the bill would strip tens of millions of Americans of their health coverage.
Some Republican governors in states that expanded Medicaid under Obamacare, such as John Kasich in Ohio, have strongly and vocally opposed earlier versions of the bill.
Because of strong opposition among conservatives in the Senate, they are expected to drastically rewrite the bill at minimum. If the bill is ultimately able to make it out of the Senate, the final product will almost surely look very little like the House’s version.