On Monday, House Republicans finally released their plan to replace the Affordable Care Act (ACA, or Obamacare). The GOP’s new plan is titled the American Health Care Act and is now being parsed by pundits, media, health care specialists and, well, everyone.
Many big questions—such as what’s the cost, who pays for the plan and who loses coverage—remain unanswered. Below are some of the big takeaways that are surfacing, particularly as they relate to the HIV community.
People with preexisting conditions will remain protected, according to the new plan. As Vox explains, people can’t be charged more or denied insurance for preexisiting conditions as long as they’ve retained continuous coverage without a lapse of more than 63 days. However, for many folks, that’s a big condition to meet. If you want to purchase health care insurance after a lapse, you’ll be hit with a hefty surcharge.
“People with chronic conditions and disabilities [like HIV] are more likely to have gaps in coverage as a direct result of their conditions,” Amy Killelea, the health reform director at the National Alliance of State & Territorial AIDS Directors (NASTAD), told Vox.
Low-income people with chronic diseases will have less financial help. “It will be harder for people living with HIV to afford plans that will actually cover their care and treatment needs,” NASTAD’s Killelea said in the same Vox article. This is because the new health plan does away with the ACA’s income-based subsidies to help low-income people and instead introduces a system of tax credits based on age.
The Medicaid expansion plan continues until 2020. This is a big change from the previous GOP plan that leaked earlier this year and that immediately cut Medicaid, the state and federal health insurance plan for low-income people. Obamacare allowed states to expand Medicaid (though many states elected not to), which has allowed significantly more people with HIV and chronic illnesses to access care and treatment. In fact, an analysis by Kaiser Family Foundation found that in states that expanded Medicaid, the number of people with HIV who were uninsured dropped from 13 percent to 7 percent between 2012 and 2014.
Under the new plan, these folks could be in limbo in a few years. Also, if the new GOP plan puts per capita caps on Medicaid spending (meaning states would allot only a fixed sum of money to each enrollee), the states might offer fewer benefits and elect not to cover more expensive treatments.
The GOP plan benefits Americans who are young, healthy and high-income, at the expense of those who are sicker or low-income. As a different Vox article explains, the new plan allows insurers to charge older enrollees more and provides tax credits to help people with more income.
Specifically, according to The Washington Post, the bill repeals a tax on individuals making at least $200,000 and married couples making $250,000. Plus, insurance company executives making over $500,000 get a tax break. Companies can usually deduct salaries as a business expense, which Obamacare capped at $500,000. In 2014, that cap resulted in $72 million in tax revenue; with the cap eliminated, the more insurance companies pay their executives the less they will pay in taxes.
How the GOP bill will make up for this missing revenue remains a mystery, as the nonpartisan Congressional Budget Offices has yet to score the bill.
Meanwhile, The New York Times offers a clear roundup of the bill and how it compares to the Affordable Care Act. In short, the House GOP bill will:
Repeal: Individual mandate, employer mandate and subsidies for out-of-pocket expenses
Change: Premium subsidies, Medicaid expansion, health savings account and restrictions on charging more for older Americans
Keep: Dependent coverage until 26, preexisting conditions policy, essential health benefits and prohibitions on annual and lifetime limits