Just before members of Congress return to Washington next week, Politico has acquired and published a draft of a House Republican Affordable Care Act repeal bill. (They host the document here).
House Majority Leader Paul Ryan has said the bill is undergoing scoring and pricing by the Congressional Budget Office (CBO) — the nonpartisan agency that reviews and projects future costs for nearly every bill approved by Congressional committees — and will be revealed in March once the CBO finishes their analysis. Keep in mind that their projections could force large changes to the bill that makes it to the House floor next week.
The bill eliminates the Affordable Care Act’s individual mandate and employer mandates, as well as a number of taxes that helped pay for the law (including taxes on tanning, over-the-counter medications and more).
The Medicaid expansion in a number of states is to be eliminated by 2020; this bill cuts federal funding for it. Eliminating the Medicaid expansion will end coverage for millions of Americans who acquired healthcare under the Affordable Care Act. The left-leaning Center on Budget and Policy Priorities calculated that a repeal will strip health coverage from almost 500,000 in the state of Kentucky alone who are now covered by Medicaid.
It also eliminates funding for Planned Parenthood entirely, though federal funding for abortions has been prohibited (in most cases) by the Hyde Amendment for over 30 years.
Also gone are the Affordable Care Act’s income-based subsidies for healthcare, a target for conservative House Republicans. In their place is an age-dependent tax credit for healthcare that gradually increases as someone ages. That credit is $2000 for those under 30, $2500 for those under 40, $3000 for those under 50, $3500 for those under 60, and $4000 for Americans 60 and over.
The bill shifts healthcare costs and responsibilities back to consumers with new emphasis on individual and shared Health Savings Accounts (HSAs). It also establishes penalties for gaps in healthcare coverage, including a 30 percent premium increase should coverage lapse in a given year.
This bill foreshadows the role Republicans see states playing in healthcare administration and delivery. It establishes $100 billion “State Innovation Grants,” which are block grants to be used in establishing high-risk pools for state residents who would otherwise be prohibitively expensive to insure and/or a number of other uses that would make individual or small-group markets more feasible for state residents.
Notably, the block grants also represent a hard limit on federal payouts; states will have to contend with concentrated populations of individuals who require more healthcare coverage than federal allocations will cover. In the past, states have turned to lifetime coverage maximums, capped enrollment and high premiums to cover and manage the exorbitant costs of administering high-risk pools. From this bill alone, it’s unclear how Republicans plan to address the issues that brought down high-risk pools in the past.
Americans with chronic or preexisting conditions would have fewer, more expensive options after a repeal; they might be covered by their state’s high-risk pool, but even that coverage might not be adequate.
The bill also abolishes the Affordable Care Act’s “Essential Health Benefits,” which were benefits that were mandated by law. With this repeal, a health insurance plan would no longer be required to cover:
- Emergency ambulance services
- Outpatient care (at clinics, doctor’s offices, etc).
- Emergency hospitalization
- Pre- and post-natal care for new mothers
- Mental health and addiction recovery treatment
- Prescription drug coverage
- Rehabilitative and habilitative care
- Laboratory services
- Preventative care, wellness services, and chronic disease treatment
There is currently just one provision in the bill to help pay for it: taxing some of the most generous healthcare plans in the country as benefits. Though Politico says this measure is favored by healthcare economists on both sides, it’s politically toxic; both unions and businesses have lobbied against similar proposals (the “Cadillac” tax, for example) in the past.