Here's the Bill to Replace Obamacare

Republicans finally released it, after keeping it in a dank basement.
March 7, 2017, 12:05am
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House Republicans have decided that their bill to repeal the Affordable Care Act is ready to be unearthed from the office building basement where they were shielding it from the prying eyes of lawmakers destined to hate it.

Unlike the draft bill leaked on February 24, this one has a name: The American Health Care Act. It would preserve the ban on denying coverage based on preexisting conditions and allow people to remain on their parents' plan until age 26.

Here's an overview of how it would change the existing law:

  • Allow people in states that expanded Medicaid to continue to enroll in the program through January 1, 2020.
  • Change Medicaid funding to "per capita caps," aka block grants, in Fiscal Year 2020 based on the number of people enrolled in the program in 2016. If states have to spend more than what they're given, they'll have to pay the difference.
  • Repeal the requirement that state Medicaid plans must cover the same "essential health benefits" as plans sold on the exchanges, starting on December 31, 2019. The House Energy and Commerce Committee's summary of the bill describes this provision as "returning flexibility to the states." Flexibility to discriminate against poor people, that is.
  • Offer tax credits based on age instead of the current income-based subsidies for purchasing health coverage; the tax credits phase out for individuals whose annual income is higher than $75,000 and households that make more than $150,000.
  • Replace the individual mandate (the penalty paid when people file their taxes if they didn't have insurance coverage the prior year) with a penalty on purchasing a new plan after a coverage lapse of longer than 63 days. Starting with the enrollment period for 2019, people who didn't maintain continuous coverage the previous year (if, say, you changed jobs) will be subject to a penalty of 30 percent on their premiums for one year when they re-enroll. 
  • Repeal the employer mandate, which required companies with at least 50 employees to provide health insurance or pay a penalty.
  • Allow insurers to charge older people premiums of up to five times as much as younger people; the current limit is three times as much.
  • Impose a one-year freeze on Medicaid reimbursement to healthcare providers that perform abortions for reasons other than rape, incest, or to save the life of the mother. (Drumbeat reminder: The Hyde Amendment already prohibits using federal funds for abortions outside of these cases.) This provision applies to Planned Parenthood and a number of other reproductive health clinics. Federal appeals court judges have ruled that this kind of exclusion is illegal.
  • Increase funding for Federally Qualified Health Centers (FQHCs) but these clinics offer comprehensive care and do not specialize in family planning. Planned Parenthood clinics are more likely than community health centers to carry the full range of contraceptive methods and offer same-day insertion of highly effective, long-acting methods like IUDs and implants. An investigation by Rewire found that some FQHCs refuse to offer IUDs because they mistakenly believe that the devices cause abortion; some don't offer contraception at all.
  • Repeal funding for the Prevention and Public Health Fund, starting in Fiscal Year 2019. The PPHF accounts for as much as 12 percent of the budget for the Centers for Disease Control and Prevention as well as half of the funding for a program that provides vaccines for underinsured kids.

We still don't know how many people the bill would cover and how much it would cost, per the Congressional Budget Office. The full text of the bill is here; updates on key changes to come.