Here is a summary of major provisions of the House bill, the American Health Care Act (AHCA):
- To help people buy insurance, if they do not have coverage at work or under a government program like Medicare or Medicaid, or through the Department of Veterans Affairs, the bill would offer $2,000 to $4,000 a year in tax credits, depending mainly on age. A family could receive up to $14,000 a year in credits. The credits would be reduced for individuals making over $75,000 a year and families making over $150,000.
- Under current rules, insurers cannot charge older adults more than three times what they charge young adults for the same coverage. The House bill would allow them to charge five times as much. The Congressional Budget Office said this change would reduce premiums for young adults and increase premiums for older Americans.
- The bill would end Medicaid as an open-ended entitlement to health care and would put the program on a budget. States would receive an allotment of federal money for each beneficiary, or, as an alternative, they could take the money in a lump sum as a block grant, with fewer federal requirements. Medicaid cuts would total $880 billion over 10 years.
- The bill encourages people to maintain “continuous coverage” by requiring insurers to impose a 30 percent surcharge on premiums for those who experience a gap in coverage.
- Under the bill, states could opt out of certain provisions of the Affordable Care Act, including one that requires insurers to provide a minimum set of health benefits, such as maternity care and emergency services, and another that prohibits them from charging higher premiums based on a person’s health status. Insurers would not be allowed to charge higher premiums to sick people unless a state had an alternative mechanism, like a high-risk pool or a reinsurance program, to help provide coverage for people with serious illnesses.
- The bill would provide states with $138 billion over 10 years that could be used for various purposes like subsidizing premiums, providing coverage to people with pre-existing conditions and paying for mental health care and the treatment of drug addiction.
Key provisions of the Republican Senate Better Care Reconciliation Act (BCRA) take effect over several years and include:
- Eliminate employer and individual mandates and related penalties, substituting a one-time premium increase of 30% for persons that were without coverage previously for a specified time period (63 days).
- States would be allowed more flexibility in establishing essential health benefits (i.e., insurance policy content).
- Change tax credit/subsidy formulas used to help pay for insurance premiums (initially age-based, later modified to income-based) and eliminate a "cost-sharing subsidy" that reduced out-of-pocket costs.
- Provide funding to health insurers to stabilize premiums and promote marketplace participation, via a "Long-Term State Stability and Innovation Program" with features analogous to a high-risk pool.
- Reduce income ceiling used for Medicaid eligibility and substitute a tax credit for those below 100% of the poverty line.
- Reduce Medicaid payments relative to current law, by capping the growth in per-enrollee payments for non-disabled children and non-disabled adults, by using a lower inflation index.
- Repeal taxes on high-income earners established under ACA/Obamacare, repeal the annual fee on health insurance providers, and delay the excise tax on high premium health plans (the so-called "Cadillac tax").
- Allow insurers to charge premiums up to five times as much to older people vs. young people, instead of three times, unless the state sets a different limit.
- Remove federal cap on the share of premiums that may go to insurers' administrative costs and profits (the "minimum medical loss ratio").
