Republicans in the U.S. House have put it on paper, i.e. how they will replace the Affordable Care Act. “It’s not sustainable, we have to do something, why not try a better way,” Representative Buddy Cater, (R) from the 1st district told me recently. Carter says insurance companies have been pulling out of the healthcare exchanges which has increased the cost of premiums (by as much as 25 percent) for those in states where the options have been declining. Carter promised any republican plan will be “patient centered and accessible.”
For some groups looking over the proposed legislation the issue isn’t necessarily access but affordability. The new bill would eliminate the mandate to buy insurance, which is an integral part of the ACA. (The idea to get many younger, healthier people into the insurance pool which would allow companies revenue to pay for the healthcare expenses of those who are older and sicker.)
The proposed bill also eliminates subsidies (used to help people buy insurance) and replaces them with tax credits. But Cindy Zeldin from Georgians for a Healthy Future doesn’t think that tax credits will be as effective in terms of helping people buy insurance. She’s doubtful a promise from President Trump and some republicans to offer better coverage to more people can be achieved. “The way the provisions are designed lead one to believe that large numbers of Americans would likely lose their health insurance under this proposal,” she told me.
Still, Zeldin said it is just a proposal and some things may change as the bill makes its way through the House and then the Senate, a process which can often take months. Meanwhile, she points out that people with coverage under the exchanges (an estimated 500,000 in Georgia) still have their insuarance.
As a matter of fact, the proposed House bill calls for much of the coverage to stay in place until up to 2020. However, it would elimiate most taxes associated with the current plan. (Republicans say it will help the free market. Democrats say it will offer less revenue to use to help people afford insurance premiums.)
In terms of tax credits, some of the criteria would be age based. “People who are older would get more in tax credits than people who are younger,” says Zelding. However, this would be paired with a change that would allow insurance companites to charge people who are older more. So there are a number of people who have been able to access coverage in the last few years who could lose it as a result of these changes.”
The proposed bill would allow companies to charge some older people up to five times more. The current ACA rules are three times.
The proposed bill also makes changes in how state run Medicaid programs are funded. By 2020, extra federal funds used to help states pay for the medical care for the very low income, would end. Then federal funds would be given to states in terms of block grants (kind of like lump sums of money) to be used as states deem fit for their own programs. States like Georgia have long requested such a change and the freedom that goes with it. However, opponents worry that at least some people who get Medicaid help now might be kicked off.