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.”
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.
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.