Public Health: Who Wins and Who Loses in the Latest G.O.P. Health Care Bill

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Young, middle-class people without pre-existing health conditions: The bill would change how insurance companies price their products in a way that would lower prices for young customers. It also gives them a flat subsidy that is, in many cases, higher than what they would receive under Obamacare. There is some variation by region, and people with pre-existing conditions could be charged higher prices in some states.

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Negotiations over the G.O.P. health care replacement bill are continuing. Here, we compile five news organizations’ estimates of the vote count.

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People who wish to go without insurance: The bill would eliminate the individual mandate, which charges a tax penalty to Americans who can afford insurance but do not obtain it.

People who want less comprehensive health coverage: The bill would allow insurers to offer health plans with higher deductibles and co-payments, a change likely to lower premiums. Customers in states that waive benefit rules may also be able to buy plans not covering as many medical services, like maternity coverage.

Large employers: The bill eliminates Obamacare’s employer mandate, which required large employers to offer affordable coverage to their workers. If the bill becomes law, companies that do not wish to cover their workers will face no penalty. All large employers would be freed of the complex reporting necessary to enforce the provision. It also pushes back enactment of a tax on high-cost employer health plans.

Medical device companies, indoor tanning companies and a few other medical industries: The bill rolls back taxes on devices, tanning, prescription drugs and health insurance products. Some of those industries may lose a little as well — insurance companies, for example, may have fewer paying customers.

Losers

Poor people: Many states would be expected to roll back their expansions of the Medicaid program to cover childless adults without disabilities. The bill would also substantially reduce subsidies available for Americans just over the poverty line, the group that benefited most from Obamacare’s subsidies. Poor Americans would be much more likely to become uninsured under the bill, according to the Congressional Budget Office, and those who retained coverage would pay much more of their limited incomes on premiums and deductibles.

Older Americans, in most states: The same factors that make the bill better for many young Americans make it worse for those who are older. Insurance companies would be allowed to charge a 64-year-old customer five times the price charged to an 18-year-old one, to cite the most extreme example. The changes in the subsidy formula would also require older middle-class Americans to pay a much larger share of their health insurance bill. The Congressional Budget Office estimates that far fewer older Americans would have insurance coverage under this bill than under the Affordable Care Act.

Maps comparing tax credits under the Affordable Care act and those in the plan House Republicans recently released across groups of incomes and ages.

People with pre-existing health conditions, particularly in some states. The bill would allow states to waive rules on minimum benefit standards and rules that prohibit insurance companies from charging higher prices to customers with a history of serious illness — or even minor diseases. And it could mean their insurance covers fewer medical services. The benefit changes could also affect Medicaid beneficiaries, and they could mean cutbacks on coverage for mental health and drug addiction treatment. States that waive the rule about prices would be required to set up a program for high-risk customers, and would get some federal funding to do so, but the details are unclear.

State governments: The bill would cut back substantially on federal funding for state Medicaid programs, while offering states only limited new flexibility in how they manage them. Over time, the changes are likely to shift an increasing share of Medicaid costs onto states.

Hospitals: Assessing an earlier version of the bill, the Congressional Budget Office estimated that some 24 million fewer people would have health insurance in a decade. Some of those people would still have medical emergencies and require hospital care. Obamacare made substantial cuts in how much Medicare pays hospitals, on the theory that they would make up the difference with more paying customers. The Republican bill would not restore any of the Medicare cuts. Hospitals in poor communities where a lot of people signed up for Medicaid would probably experience the biggest hit.

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Source: New York Times

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