A look at how the revised Senate health care bill would affect you.
WASHINGTON — Senate Republicans Thursday released a revised version of their plan to replace Obamacare — dumping some tax cuts for the wealthy, allowing for more insurance policies with limited coverage and increasing funding to fight the opioid addiction epidemic.
But it’s unclear whether the changes are enough to win over moderates concerned that the bill’s cuts to Medicaid and private insurance subsidies will leave millions without care, or whether conservatives are satisfied the bill would repeal enough of the Affordable Care Act’s taxes and regulations.
Majority Leader Mitch McConnell, R-Ky., had to scrap a planned Senate vote at the end of June because he could not round up the 50 Republican votes he needs to advance the legislation. Thursday he said the Senate will vote on the bill next week, even though there are still wavering Republican senators who have not committed to vote for it.
Here’s a look at what is in the revised bill, and how it could affect you.
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.
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.
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.
If an insurer offers plans that meet the ACA’s requirements — including covering minimum benefits and not charging sicker people more — the insurer 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, 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.
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
The bill would still sunset in two years cost-sharing subsidies for low- and middle-income 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.
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.
The bill would not change the ACA’s rule that dependent children can stay on a parent’s plan until age 26.
If you are among the more than 14 million Americans who gained eligibility through the ACA, you could still lose it. Enhanced federal funding for the low-income adults who became newly qualified 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 new limit on federal Medicaid dollars.
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 would have to wait six months before they can re-enroll.
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.
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.
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.
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.
