How the GOP health-care bill could affect you

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WASHINGTON – President Donald Trump and Republicans who control Congress are advancing a sweeping health-care bill that would make some significant changes to “Obamacare” but not completely repeal the current national health care law. In fact, the GOP proposal would keep some significant elements of Obamacare.

Many specifics are not yet known but here is a look at some of the changes and how they might impact people in different age groups, based on examples offered by the Kaiser Foundation and the Congressional Budget Office.

Use the arrows to the right of each section to navigate through this project.

the bill's main points

Mandate vs. choice

  

The mandate that every individual get health insurance or pay a penalty to offset health-care costs would be eliminated. Also, large employers would no longer have to cover workers or face a penalty if they don’t.

Philosophically, this is the crucial hinge for many Republicans: switching from mandates to choices.

“It comes down to whether you want government playing a predominant role in determining what (health care coverage) should be offered in or whether you think (insurers) should be allowed to offer plans” that fit the market, said Rep. John Faso (R-Kinderhook), the lone New York Republican on the House Budget Committee. “The ACA represents a centralized approach. The Republican approach lets the market work and lets individuals decide what to buy.”

Tax credits:

The Republican plan would replace Obamacare tax credits with a different kind of tax credit. In short, Obamacare provided tax credits based on incomes and costs of policies; the GOP would base it on age. Further, the GOP would cap the maximum credit at $4,000 for people 60 years old or greater; under Obamacare, the credits could be $10,000 or more.

Enrollment and premiums:

The Congressional Budget Office projected that health-care premiums would spike 20 percent for those buying in the individual market during the first 10 years, but decline by 10 percent overall in a decade. But again, individual circumstances can vary widely.

Medicaid:

 

The GOP plan would keep federal funding of Obamacare’s Medicaid expansion through 2020, but halt it after that. The expansion had allowed people who earned just enough money to be excluded from Medicaid to join it. That will end. People in this income category will be among those most affected, in the future, by the proposed changes.

Popular elements of Obamacare:

 

The GOP would keep some key parts of the ACA that are popular: Insurers wouldn’t be able to deny coverage to people with pre-existing conditions; children would be able to stay on their parents’ policies until age 26; insurers can’t cap annual or lifetime medical expenses.

Women’s health issues:

The GOP would freeze Planned Parenthood funding for one year. The organization gets nearly half its funding from the federal government, according to Associated Press, and the aid doesn’t pay for abortions but rather other services such as birth control and treatment of sexually transmitted diseases.

Further, the GOP plan prohibits the use of tax credits to purchase any health plan that covers abortions.

Mental health, substance abuse:

For the 31 states that expanded Medicaid under Obamacare (including New York), the GOP plan would eliminate (in 2020) the requirement that Medicaid cover mental-health and substance-abuse treatment. That doesn’t mean states won’t continue to cover those services, but they will be among the mix of coverage choices.

Some Democrats and some health-policy groups view this as a “major retreat” from substance-abuse treatment.

on family insurance

You’ll be able to stay on your parent’s policy until age 26. The GOP would keep this popular provision of the ACA.

Also read the section for ANY age to learn more about possible changes in coverage.

on employer insurance

If you get health insurance through your job, the GOP plan would not have a huge effect on you, said Bill Hammond, a health-care policy analyst at the Empire Center.

The overwhelming majority of companies provide health insurance because it is part of the traditional package to attract employees or “because they think it’s the right thing to do,” Hammond said. The removal of the penalties likely won’t spur companies to suddenly drop coverage.

That said, companies could alter what their policies cover based on how the market shakes out. The Congressional Budget Office projected that up to 7 million fewer people would be covered through work-offered insurance by 2026 because companies no longer face a penalty. Republicans called that estimate overstated.

Also read the section for ANY age to learn more about possible changes in coverage.

buying insurance

 

Like the ACA, the Republican plan primarily affects those who must buy insurance on their own — especially young adults and senior citizens. And the impact depends on a person’s circumstances.

If you are a Long Islander who is 27 (no longer covered by your parent’s policies) and you are earning less than $50,000, you’d fare better under Obamacare. If you were earning more than that (up to $75,000), you’d fare better under the GOP plan.

But it’s not just tax credits that would change, it’s likely premiums would too. Younger individuals likely would see lower insurance premiums. That’s because the GOP plan, according to supporters, recognizes that young people have fewer health costs and should pay less.

Also read the section for ANY age to learn more about possible changes in coverage.

on employer insurance

If you get health insurance through your job, the GOP plan would not have a huge effect on you, said Bill Hammond, a health-care policy analyst at the Empire Center.

The overwhelming majority of companies provide health insurance because it is part of the traditional package to attract employees or “because they think it’s the right thing to do,” Hammond said. The removal of the penalties likely won’t spur companies to suddenly drop coverage.

That said, companies could alter what their policies cover based on how the market shakes out. The Congressional Budget Office projected that up to 7 million fewer people would be covered through work-offered insurance by 2026 because companies no longer face a penalty. Republicans called that estimate overstated.

Also read the section for ANY age to learn more about possible changes in coverage.

buying insurance

Like the ACA, the Republican plan primarily affects those who must buy insurance on their own – especially young adults and senior citizens. And the impact depends on a person’s circumstances.

If you are a 40-year-old Long Islander and your income is $30,000, you’d be eligible for $3,000 in tax credits under the GOP plan and $3,930 under Obamacare, according to Kaiser. That same person earning $75,000 in income would fare better under the GOP plan because his income level is too high to get any tax credits under Obamacare. (If that person earns $100,000 or more, he/she could get just $500 in tax credits in the GOP plan.)

But it’s not just tax credits that would change, it’s likely premiums would too. The CBO projected that premiums for a 40-year-old are likely to decrease.

Those who currently earn too much to qualify for Medicaid or Obamacare subsidies likely would fare better under the GOP plan. For example, a 40-year-old who earns $68,200 annually would pay $6,500 in premiums under Obamacare but $2,400 under the GOP plan.

Also see changes for ANY age to read more about changes that could affect your coverage.

on employer insurance

If you get health insurance through your job, the GOP plan would not have a huge effect on you, said Bill Hammond, a health-care policy analyst at the Empire Center.

The overwhelming majority of companies provide health insurance because it is part of the traditional package to attract employees or “because they think it’s the right thing to do,” Hammond said. The removal of the penalties likely won’t spur companies to suddenly drop coverage.

That said, companies could alter what their policies cover based on how the market shakes out. The Congressional Budget Office projected that up to 7 million fewer people would be covered through work-offered insurance by 2026 because companies no longer face a penalty. Republicans called that estimate overstated.

Also read the section for ANY age to learn more about possible changes in coverage.

buying insurance

If you a Long Islander 60 or older and your income is $30,000, it’s essentially a wash: you’d be eligible for $4,000 in tax credits under the GOP plan and $3,930 under Obamacare, according to Kaiser. That same person earning $75,000 in income would fare better under the GOP plan because his income level is too high to get any tax credits under Obamacare. (If that person earns $100,000 or more, he/she could get just $1,500 in tax credits in the GOP plan.)

But it’s not just tax credits that would change, it’s likely premiums would too. Persons 60 or older who are buying on the individual market likely would see premiums rise. Under Obamacare, insurers could charge older adults up to 3 times as high as young adults. The GOP would change that ratio to 5-to-1.

For example, the CBO said that a 64-year-old with a $26,500 income would pay $1,700 in premiums in 2026 under Obamacare – but a whopping $14,600 under the GOP bill.

changes for employers, insurers

 Most of them would go away. The GOP would eliminate the mandate penalty, fees on insurers and prescription drug manufacturers, taxes on the sales of certain medical devices, a surcharge on investment incomes and the 10 percent tax on indoor tanning services.

But, importantly, the GOP would keep the so-called Cadillac tax. Scheduled to begin in 2020, this Obamacare provision would impose an excise tax (paid by insurers and employers, not individuals) on health plans that cost more than $10,200 for individuals and $27,500 for families. The GOP would delay the phase-in by five years.

Supporters say the tax is a governor on health-care spending. Some Republicans, though, want to kill all the taxes imposed by Obamacare.

“My view is this: After spending seven years talking about the harm being caused by these taxes, it’s difficult to switch gears now and decide that they’re fine so long as they’re being used to pay for our healthcare bill,” Sen. Orrin Hatch (R-Utah) told The Hill.

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