Comparing the Senate health care bill with the AHCA and ACA

Yesterday Senate Majority Leader Mitch McConnell unveiled the Senate Republicans’ health-care bill draft, the Better Care Reconciliation Act of 2017.

The discussion draft, written by a group of 13 Republican Senators, will likely evolve before the Senate’s vote. McConnell needs 50 yes votes, assuming Vice President Pence will vote yes to break the tie, in order for the bill to pass. You can check out where each senator stands here.

We compare current law under the ACA with both the AHCA and the Senate’s discussion draft.

Uninsured Population

The ACA lowered the national insurance rate by 16 percent from 2010 to 2016 according to the National Center for Health Statistics. As of 2016, 8.8 percent of Americans were uninsured.

Under the AHCA, the national uninsured rate is projected to rise to 18 percent by 2026, or 23 million people, according to the Congressional Budget Office.

The CBO score has not been released for the Senate bill, but given other provisions in the bill, it is likely that the insurance rate will increase. Update: The Senate bill is projected to leave an additional 22 million people uninsured according to the CBO.

Individual Mandate

The ACA requires anyone who is uninsured to pay a tax penalty.

The AHCA repeals the individual mandate, but requires anyone who remains uninsured for more than two months to pay a 30 percent premium surcharge when they purchase a new plan.

The Senate bill also repeals the individual mandate, but does not include penalties for remaining uninsured. Update: The Senate bill would create a 6 month waiting period for people who go without insurance for more than 63 days.

Tax Credits

Under the ACA, consumers who have an income up to 400 percent of the federal poverty level and purchase plans through the marketplaces can receive tax credits. Credits are based on income and the local cost of insurance.

Under the AHCA, the credits would be restricted to consumers who earn less than $75,00 a year and the amounts would be tied to age instead of income, with credits increasing with age as shown in the chart below.

Tax credits under the AHCA.


Under the Senate bill, credits would be tied to income, but would stop at 350 percent of the federal poverty level. The credits would be determined using a new formula. The credits would decrease as age and income increases, as shown in the chart below. The bill would also lower the actuarial value from 70 percent under the ACA to 58 percent, which would also reduce the value of tax credits.

Percent of income spent on premiums under Senate bill’s tax credit structure depending on age and income, up to 350 percent of the federal poverty level.


Cost Sharing Reduction Payments

Under the ACA, carriers receive CSRs to offset the cost of providing affordable coverage to high-cost or low-income consumers.

Under the AHCA, CSRs would end in 2020.

Under the Senate bill, CSRs would be funded through 2019.

Guaranteed Coverage

Under the ACA, insurers cannot deny coverage or charge more for coverage for people with pre-existing conditions. Insurers cannot impose annual or lifetime limits and must offer coverage for the essential health benefits.

Under the AHCA, state can seek waivers to scale back the essential health benefits and would allow insurers to charge more for pre-existing conditions.

The Senate bill would allow states to seek waivers that could allow insurers to impose annual and lifetime limits, and cut back on the essential health benefits.

Age Band Rating

Under the ACA, the age band rating is 3:1, meaning older consumers cannot be charged more than three times what younger consumers are charged.

Both GOP bills would raise the age band rating to 5:1.

Women’s health

Under the ACA, women cannot be charged more than men for the same health plan. Maternity care, pediatric care, and contraception are required to be covered.

Both GOP bills would bar insurance companies for charging women more for the same health plan. However, the essential health benefits could be scaled back under state waivers, leading to higher costs for maternity care and contraceptives.

Planned Parenthood

Under the ACA, Planned Parenthood receives federal funding. Federal funding received by Planned Parenthood is not used to fund abortions. Federal Medicaid funds can be used to fund on abortions in the case of rape, incest, or if the mother’s life is at risk.

Both GOP bills would bar Medicaid from providing funding for any health clinics that provide abortion services, meaning Planned Parenthood would essentially be de-funded. Federal funding makes up 43 percent of Planned Parenthood’s revenue and abortions make up 3 percent of overall health services.

Taxes

The ACA increased taxes for insurance companies, medical device makers, and wealthy Americans.

Both GOP bills would give tax cuts to insurance companies, medical device makers, and wealthy Americans. The cuts would total roughly $663 billion over the next ten years.

Deficit

The ACHA would cut the federal deficit by $118.7 billion by 2026 according to the CBO score.

Update: The Senate bill would cut the federal deficit by $321 billion by 2026 according to the CBO score.

Medicaid

The ACA allowed states to expand Medicaid to people with incomes below 138 percent of the federal poverty level. The federal government is covering the majority of the costs of the expansion in 30 states and DC. The federal government pays states for a specified percentage of Medicaid expenditures.

The AHCA would phase out the expansion of Medicaid beginning in 2020 and the would shut down in 2024. IT would also replace current Medicaid funding with a per capita cap, which would increase annually with the inflation rate. The CBO estimated that 14 million people would lose Medicaid coverage and federal Medicaid spending would be reduced by $834 billion.

The Senate bill would also replace the current Medicaid funding with a per capita cap, which would increase with inflation. The expansion would phase out over four years, with 90 percent of current federal funding being provided in 2020, with a 5 percent decrease each year until 2023. After 2020, people would not be allowed to join the expansion. State would be allowed to institute work requirements to be eligible for Medicaid, unless they are a student, pregnant, or disabled. Update: The CBO estimated that 15 million people would lose Medicaid coverage over the next decade. Medicaid funding would decline by 26 percent by 2026 compared to the current law.

Other Senate Bill Funds

The Senate bill would create a $50 billion stabilization fund for states over the next four years, with $15 billion a year for 2018 and 2019 and $10 billion a year in 2020 and 2021.

The Senate bill would also create a state innovation fund of $62 billion over the next eight years to help high-cost and low-income people purchase insurance.