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7 Scary Things from the Leaked Obamacare Repeal Bill

People in stingy states could lose coverage for mental health services, birth control, and more.
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Politico has obtained a draft of House Republicans' bill to repeal the Affordable Care Act, aka Obamacare. This bill will likely change as it moves through House committees and after it's reviewed by the Congressional budget office, but the draft offers a first glimpse at what Republicans might do.

Here are the biggest potential changes you should know about. The bill would:

Roll back the Medicaid expansion
As part of Obamacare, 32 states opted to expand their qualifications for Medicaid coverage so more people with low incomes could have health insurance. The bill would phase out these expansions by 2020, widening the coverage gap once again.


Institute Medicaid block grants
Instead each state would receive a capped payment based on the number of people enrolled in Medicaid, with variations based on health status. Still, this means states could run out of money in their Medicaid funds.

Allow states to choose which services to cover
The bill would repeal the ACA's essential health benefits requirements, which say that insurers must cover ten categories of services. Those categories are:

1) ambulatory patient services; (2) emergency services; (3) hospitalization; (4) maternity and newborn care; (5) mental health and substance use disorder services including behavioral health treatment; (6) prescription drugs; (7) rehabilitative and habilitative services and devices; (8) laboratory services; (9) preventive and wellness services and chronic disease management; and (10) pediatric services, including oral and vision care.

Instead, states would choose which services to cover starting in 2020. Experts worry about the loss of coverage for addiction treatment and birth control (which is considered a preventive service for women alongside cancer screenings and STD testing). They're also concerned that women could be charged more for their health insurance if it doesn't automatically include maternity care.

Block Planned Parenthood from Medicaid reimbursement
The bill would block healthcare providers that offer abortion for reasons other than rape, incest, or to save the life of the mother from receiving Medicaid reimbursement. Essentially, people with Medicaid would not be able to receive ANY type of care at Planned Parenthood or other reproductive health clinics. A federal appeals court judge ruled on Tuesday that Texas could not legally exclude Planned Parenthood from Medicaid—suggesting that such a block, should the administration try to implement it, could get reversed in court.


Penalize people who don't have continuous coverage
If a person's coverage lapses, their premiums will be up to 30 percent higher when they re-enroll (for one plan year). This penalty is designed to encourage people to keep their coverage, but it may have the unintended consequence of discouraging them from re-enrolling once they've lost it. (Insurers need both healthy and less-healthy people to buy insurance in order to cover their costs.)

Nix a preventive health fund that gives out vaccines
The bill would cut off the Prevention and Public Health Fund, which supports various initiatives, in 2019. Among other things, the PPHF provides half of the money for a federal program that covers vaccines for underinsured children and uninsured adults and accounts for up to 12 percent of the Centers for Disease Control and Prevention's budget.

Allow insurers to charge older people more
The bill does NOT remove the provision that people can't be charged more for having pre-existing conditions, but it would allow insurers to charge older customers more than they're paying now (up to five times as much as younger people versus the 3x limit currently imposed).

Republicans propose to pay for their plan by limiting tax breaks on the most expensive employer-sponsored health plans. Read more at Politico.

This story will be updated as more information becomes available.

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