How the Republican Healthcare
Act Compares to the Affordable Care Act
The Republican plan, euphemistically referred to as
Trumpcare addresses insurance and not improvements in healthcare delivery.
Insurance is NOT health care. This analysis examines how the proposed healthcare
plan in House Bill 277 differs from the Affordable Care Act, known as Obamacare.
For information on ACA improvements in health care at the patient level, refer
to the link below.[1] This article cites credible sources from
nonprofit entities or government agencies and only facts are used, not false proclamations.
|
Criteria
|
Obamacare
|
Trumpcare
|
|
Medicaid Coverage is medical insurance for low-income
folks
Eligibility Standards
|
Expanded eligibility for Medicaid to 138% of the federal
poverty level; 32 states opted to expand coverage, increasing access to
healthcare for 11 million people.[2]
|
Beginning in 2020, repeals the Medicaid expansion, allowing
existing Medicaid participants to remain, but with the inability to re-enter later
if you lose your eligibility; Millions would lose their medical insurance.
|
|
Mental Health Benefit
Mandate
|
Expanded to include mental health parity, to increase
access to health treatment for mental conditions under the essential benefit
provisions of the ACA.
|
Insurance companies would no longer have to offer mental
health benefits under insurance contracts.
|
|
Substance Abuse Treatment
Mandate
|
Plans were required to offer coverage for substance abuse
treatment, comparable to other illnesses and it is estimated 5 million people
have used this benefit.
|
Insurance companies are not required to offer treatment
for drug addiction, which is problematic given the national crisis in opioid
addiction, currently killing 91 people a day.
|
|
Employer Insurance
Mandate
|
Required employers to offer medical insurance within
standardized benefit levels, or pay a fine.
|
Employers will no longer be required to offer medical
insurance for their employees and no fines will be levied. Small business tax
credits, to help businesses offer medical insurance are cancelled in 2020.
|
|
Impact on Individuals in Insurance Exchanges
|
Required pooled rates, which were spread across age bands,
not individual levels; creating more affordability.
|
Insurance companies can age rate, to increase pricing
toward older participants (those most likely to need more health services).
Cost sharing provisions which helped low income people are eliminated.
|
|
Taxes to fund the plan
|
Follow the link to a previous article which detailed the
taxes.[3]
Most sectors of the healthcare system contributed to taxes to fund the
provisions of the Affordable Care Act which is self-funding.
|
Would eliminate most of the taxes except the “Cadillac Healthplan
Tax”, lower capital gains for the top 2.5% of income earners, and charge all
employees covered on insurance plans through their employers, a Value-Added
Tax (like the Canadians charge on services).
|
|
Women’s Healthcare
Mandates
|
Mandated insurance plans cover birth control and women’s gynecological
exams annually.
|
Defunds all Planned Parenthood Services and removes the
requirement to provide wellness services or birth control.
|
|
Financial Impact on Individuals
|
Older low income people had greater subsidies so they
could buy medical insurance.
|
Older low income folks will pay thousands more per year
for medical insurance. Young people will pay less for insurance, but since
there are no penalties for not participating enrollment will decline, eroding
the overall viability of insurance exchanges.
|
|
Employer Provided Medical Plans
|
Employers can deduct the full cost of their medical and
other benefit plans and employees are not taxed on these benefits.
|
Eliminates the tax advantage for employers which will
cause the cancellation of many health plans across the nation because this is
a very expensive benefit for employers to offer. Example, your employer pays
$12,000 in insurance plan premiums for you, these would now be taxable as
income to the employee and nondeductible to the business.
|
|
Individual Penalties for Not Participating
Tax Laws
|
Proof of insurance is required at income tax filing. A tax
penalty up to $695 per adult ($2,085 family) is due unless you qualify for
one of the many exemptions, which include your inability to afford insurance.
|
No requirement to have medical insurance, but if your
coverage lapses, you will pay a penalty (up to 30%) upon re-enrollment
regardless of your income. The penalty would be meted out by the insurance
company.
|
|
Medicaid Funding
|
Affordable Care Act provides additional subsidies to
states for the expansion of Medicaid, to increase insurance coverage and
access to medical care across the nation.
|
Republican plan wants to cap any federal Medicaid
contribution to a flat amount per person, without cost-of-living increases
and not based on actual plan costs.
|
A quick analysis of this doomsday health insurance scheme,
eliminates most incentives, especially for the bottom 25%-of-income-households
and a swath of the middleclass, to obtain medical insurance. By removing the
tax incentive for employers to provide health plans more Americans will lose medical
insurance through their employment, throwing more people into the chasm of the
uninsured. By removing the tax credits for small firms, fewer of those will be
able to offer medical insurance to their workers. And the piece de resistance
of this Trump sanctioned health plan is to further destabilize the insurance
exchanges, by removing the accountability requirement that residents have
medical insurance. Plus, allowing the insurance companies to eliminate or
reduce specific medical conditions will harm treatment for public health needs.
Older individuals will face steep premium increases as the Republican plan
allows insurance companies to charge older Americans up to five times what they
charge the younger ones. In other words, back to business as usual for the
insurance industry, where they can eliminate an entire “class” of people from
their contracts and of course, charging those most in need significantly higher
premiums.
Finally, there isn’t one thing about this “plan” that addresses
the improvement of health care, lowers the cost of your health care treatment,
or encourages transparency and accountability from any of the price gouging
suppliers. More to come on the provisions which will impede consumer
protections and create road blocks on price and quality transparency for
consumers. Of course, can we really expect anything else from an administration
which felt ethics classes were unnecessary, and refuses to allow adequate time
for public comment on a bill which would be so harmful to people?
For the best interactive tool to see how you would fare
under the Republican Health Plan, follow the link below to the nonprofit,
Kaiser Family Foundation site and search for your age and county to get your
tax credit information. The Republican plan only provides tax credits based on
age, not on income, with a phase-out at $75,000.[4]
And this is the healthpolicymaven signing off wishing you
fully informed consent for any medical procedure, contract, or act. Roberta E. Winter
is a former insurance broker and healthcare consultant, who has been devoted to healthcare reforms
since 2002 and is the author of https://www.amazon.com/Unraveling-U-S-Health-Care-Personal/dp/1442222972
.
References
Centers for Disease Control and Prevention. (2016). Drug
Overdose Deaths Continued to Increase in 2015. Health and Human Services,
Centers for Disease Control and Prevention. Centers for Disease Control and
Prevention. Retrieved March 12, 2017, from
https://www.cdc.gov/drugoverdose/epidemic/index.html
Gunja, S. R. (2017, March 7). Why Millions Would
Lose Coverage Under the Medicaid Expansion Changes in the House Affordable
Care Act Repeal Bill. To the Point-Quick Takes on Health Care Policy and
Practice. Retrieved March 12, 2017, from
http://www.commonwealthfund.org/publications/blog/2017/mar/why-millions-would-lose-coverage-under-affordable-care-act-repeal-bill
Jost, T. (2016). Affordability: The Most Urgent
Health Reform Issue For Ordinary Americans. Health Affairs.org. Health
Affairs . Retrieved March 12, 17, from
http://healthaffairs.org/blog/2016/02/29/affordability-the-most-urgent-health-reform-issue-for-ordinary-americans/
Kaiser Family Foundation.org. (2017). Tax Credits
Under the Affordable Care Act Versus the American Health Care Act. The
Henry J. Kaiser Family Foundation. The Henry J. Kaiser Family Foundation.
Retrieved March 7, 2017, from
http://kff.org/interactive/tax-credits-under-the-affordable-care-act-vs-replacement-proposal-interactive-map/
Kirsten Beronio, R. P. (2013). AFFORDABLE CARE
ACT EXPANDS MENTAL HEALTH AND SUBSTANCE USE DISORDER BENEFITS AND FEDERAL
PARITY PROTECTIONS FOR 62 MILLION AMERICANS. Health and Human
Services.gov, Office of the Assistant Secretary for Planning and Evaluation.
U.S. Department of Health and Human Services. Retrieved March 12, 2017, from
https://aspe.hhs.gov/report/affordable-care-act-expands-mental-health-and-substance-use-disorder-benefits-and-federal-parity-protections-62-million-americans
