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Monday, May 8, 2017

Trumpcare vs. Obamacare


Boy, Washington’s been quite a-flutter lately, hasn’t it? Just last week, the House of Representatives voted 217 to 213 to pass the GOP health care bill meant to replace the Affordable Care Act (ACA).

The GOP’s legislature has been called the American Health Care Act (AHCA) and has been called out by various media, medical, and advocacy groups for the potentially detrimental changes should it succeed in repealing the ACA. The American Medical Association even had this to say about the new law:

The bill passed by the House [today] will result in millions of Americans losing access to quality, affordable health insurance and those with pre-existing health conditions face the possibility of going back to the time when insurers could charge them premiums that made access to coverage out of the question.

The House GOP, however, maintains that the proposal would allow individuals and states more options when it comes to health insurance which should, in turn, make coverage more affordable overall.

So what are the main differences between the current legislature (the Affordable Care Act aka the ACA aka Obamacare) and the bill that still needs to pass through an increasingly reluctant Senate (the American Health Care Act aka the AHCA aka Trumpcare)? Well, sit back, because we’re here to tell ya!

Coverage
The ACA
The Affordable Care Act introduced legislation that made it illegal for insurers to charge those with preexisting conditions more for coverage; it also made it illegal for insurers to charge older consumers more than three times what they charge younger consumers. It also barred insurers from imposing annual or lifetime limits on coverage. Under the ACA, individuals were also required to enroll in health insurance coverage or pay a tax penalty.

The AHCA
Under the GOP’s new option, how coverage for those with preexisting conditions is handled would be left up to the states. Guaranteed coverage is not explicitly eliminated, but states can seek waivers from several consumer protections. States would also be allowed to scale back benefits insurers must cover; with how the law is structured, insurers could reimpose annual and lifetime limits on certain coverage. Insurers in states that allowed it would also be able to charge sick consumers more as well as charge older consumers as much as five times more than younger consumers. The AHCA does drop the tax penalty imposed for not having health insurance, but anyone who goes without insurance for more than two months would incur a 30% premium surcharge when they tried to purchase a new plan.

Number of Uninsured
The ACA
Thanks in part to the tax penalty imposed by the ACA - and also in part to the tax subsidies it offered - the Department of Health and Human Services (HHS) recently announced an unprecedented 20 million people became newly insured as a result of the ACA. Currently, the estimated amount of uninsured people in America is approximately 28 million.

The AHCA
While the Congressional Budget Office (CBO) is still completing its independent analysis of the AHCA, it’s unclear how the revised bill would change the original estimate of growth in uninsured citizens with the new legislation. The CBO initially predicted, based on the original version of the GOP health care plan, about 24 million more Americans would lose coverage by 2026, mostly affecting low-income Americans and those nearing retirement. Of course, we’re still waiting on the nonpartisan CBO’s latest analysis to determine if this has changed any with the newest updates.

Insurance Subsidies
The ACA
Under the ACA, insurance subsidies worked a little like this:
  • -Those using the healthcare marketplace who make less than $48,000 a year receive subsidies to help buy insurance.
  • -The amount of that subsidy is directly related to the person’s income and the cost of insurance where they live.
  • -The subsidy is automatically applied to the consumer’s monthly insurance bill rather than having the consumer wait for a rebate.
The AHCA
Under the AHCA, insurance subsidies will work a little like this:
  • -People are still eligible for subsidies, however, they will phase out at incomes of $75,000/year.
  • -The amount of the subsidy is directly related to the person’s age but will not vary based on the cost of coverage in the area. The newest tax credit proposal is as follows:
    • -Age 20-29: $2,000
    • -Age 30-39: $2,500
    • -Age 40-49: $3,000
    • -Age 50-59: $3,500
    • -Age 60+: $4,000
In General
As far as subsidies go, it will all depend on your income, age, and location as to whether the ACA or AHCA is a better deal for you. As the Kaiser Family Foundation study pointed out, for instance, an older, lower-income American living in an area with higher premiums (like Alaska or Arizona) will likely lose out if the ACA is replaced. However, a younger, higher-income American in an area with lower premiums (like Massachusetts or Washington) may receive assistance under the AHCA.

Medicaid
The ACA
One of the components of the ACA helped to expand Medicaid to cover more Americans. Under the ACA, the federal government allots money to states depending on how much medical care the state’s Medicaid patients receive. This ended up with the federal government covering almost the entire cost of expanding Medicaid coverage to low-income adults without children in the 30 states and D.C. that elected to expand their programs.

The AHCA
The AHCA proposes a fixed “per capita cap” or “block grant” to replace the current Medicaid system, which is decades old. Under this new system, each state would receive a fixed amount of money each year that increases annually by a percentage linked to the inflation rate. Any additional federal funding that was allotted for coverage Medicaid expansion would be eliminated by 2020.

Tax Changes
The ACA
Through the ACA, taxes were set up to pay for subsidizing insurance to ensure more covered individuals. With these tax requirements, insurance companies and medical device makers, as well as taxpayers with incomes over $250,000, were taxed more to cover the subsidies provided under Obamacare.

The AHCA
The AHCA eliminates most of these taxes, arguably making this proposal much more beneficial for medical device makers, insurance companies, and wealthy Americans. While these tax cuts total about $600 billion over the next decade, the GOP proposal does not include any new tax to offset this loss of revenue.




As the Senate debates and prepares for the vote on the GOP’s new health care proposal, we’ll be here making sure you have all the information (and e-filing product) you need to be prepared for any upcoming ACA or AHCA reporting! So be sure to stay tuned with ACAwise for the health care reporting information you need when you need it!

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