The GOP's American Health Care Act narrowly passed the House on Thursday afternoon. Here are some answers to questions on what this legislation could mean for consumers.
What happens next?
The legislation goes to the Senate, where a special procedure known as reconciliation is being used so the bill needs only a simple majority (51 votes) to pass. There are 52 Republicans in the Senate, so if there are GOP defections, Vice President Pence may be needed to break a tie, assuming all Democrats vote no on the bill. Reconciliation rules also mean, however, that some provisions in the House bill might have to be taken out to meet Senate requirements. If that happens, the House would have to approve the new Senate version. If that is successful, the bill goes to President Trump, who is expected to sign it into law.
Would this bill repeal the Affordable Care Act?
Partially. The bill is a first-stage effort that was supposed to address only the parts of the ACA with budget impacts in order to avoid the need for a filibuster-proof, 60-vote majority in the Senate. But it still has very wide implications, hitting on just about all of the health insurance system.
I have a preexisting condition, and the ACA meant insurers had to cover me at no greater cost than others in the general insurance pool. What would the GOP plan mean for me?
An amendment crafted by Rep. Tom MacArthur (R., N.J.) allows states to obtain a waiver so people with preexisting conditions can be charged higher premiums. Rep. Fred Upton (R., Mich.) led an effort to add $8 billion over five years to help these people pay for increased premiums and out-of-pocket costs. However, numerous medical and consumer advocacy groups say this won't be enough to offset the true added expenses.
I get subsidies through the Affordable Care Act to pay for my individual health insurance policy. What happens to those?
This bill would substantially reduce funding for subsidies the ACA provides to most people covered through insurance marketplaces. At the same time, however, it makes changes that, overall, would help younger adults and increase premiums for older people. The bill also would eliminate several taxes the ACA created to help pay for its provisions, including on health insurers.
What happens to older people who aren't yet old enough (65) for Medicare?
Under the ACA, insurers were limited to charging their oldest customers no more than three times the prices paid by younger ones. The GOP plan increases that limit to five times more -- but states could apply for a waiver and allow even higher charges.
Would this new plan get rid of the individual mandate to have health insurance?
Not exactly. It does eliminate the penalty for not having insurance, but it allows insurers to tack on a 30 percent surcharge to their rates for people who allow their coverage to lapse for at least 63 days, in order to discourage people from skipping insurance until they get sick.
I recently qualified for Medicaid in Pennsylvania after the state expanded its program under the ACA. What happens to me?
The Congressional Budget Office has estimated that over the next decade, the GOP bill would cut $880 billion from the Medicaid program, which covers low-income Americans and helps pay for long-term care for seniors and the disabled. People in Pennsylvania, New Jersey, and other states that chose to expand their Medicaid programs would still be covered for the next few years, as long as they maintained continuous coverage.
What happens in a few years?
Starting in 2020, Medicaid would switch to a "block grant" funding system, meaning that each state would be given a certain amount per person each year, rather than the current system that increases funding as demand for care increases. Critics say the change, intended to contain government health-care spending, would harm Medicaid beneficiaries.
What about lifetime coverage limits?
The ACA banned insurers from imposing lifetime limits on what they pay to cover an individual. The GOP plan maintains that policy, but some coverage caps could become possible in states that waive "essential health benefits" rules.
I'm on Medicare. What happens to my coverage?
The GOP plan does not mean big changes for Medicare. But it would kill the Medicare payroll surtax on high earners, cutting money for the hospital trust fund to keep it solvent longer, money that would need to be found elsewhere. Also, poor seniors who qualify for both Medicare and Medicaid could be affected by cuts in Medicaid.
I have insurance through my employer. How could the bill affect me?
If your state seeks a waiver from the 10 "essential health benefits" required under the ACA (this includes areas like maternity care and mental-health treatment including substance-abuse treatment), your employer could choose a more limited plan than you have now. Also, the GOP bill allows people to put more money into Health Savings Accounts (HSAs) and to use the funds for over-the-counter medications without a prescription.
Does the new plan help cut the deficit?
According to a CBO estimate issued in late March, the House GOP plan would cut the federal deficit by $150 billion between 2017 and 2026. But since the bill has changed since then, the CBO needs to update its estimate.
How many people would lose their insurance under this plan?
The CBO said in March the bill would result in 24 million fewer Americans being insured by 2026, including 220,000 Philadelphians, Mayor Kenney's office said Thursday.