Medicaid expansion
CHANGE
OBAMACARE Raised the eligibility cutoff to 138 percent of the poverty level in any state that chose to expand the program, around $16,000 for a single person. The federal government pays at least 90 percent of the costs for newly eligible beneficiaries.
SENATE BILL Allows the 31 states that expanded Medicaid to continue getting federal funding through 2023, with reduced funding starting in 2021. The bill sharply curtails federal support for Medicaid expansion in 2024, likely causing many states to end the expansion.
Separate from the expansion, the bill caps future federal funding per enrollee, based on how much each state has spent historically. States also have the option to receive a lump-sum block grant for some beneficiaries.
The Congressional Budget Office estimated that similar policies in the bill passed by the House would cut more than $800 billion from the program over a decade. The Senate formula puts the program on a budget and substantially reduces future Medicaid spending.
Taxes created under the Affordable Care Act
REPEAL
OBAMACARE Imposed new taxes to help pay for coverage expansion. They include taxes on investment income, wages above $200,000, medical devices, prescription drugs and indoor tanning.SENATE BILL Permanently eliminates most of the taxes. A tax on high-cost employer health plans, established under Obamacare, but yet to kick in, would be imposed beginning in 2026.
Subsidies for out-of-pocket costs
REPEAL
OBAMACARE Provides subsidies to help people with lower incomes pay for out-of-pocket costs like deductibles and co-payments.
SENATE BILL Preserves the subsidies through 2019, then eliminates them altogether. This means many low-income people would face high deductibles.
Tax credits for premiums
CHANGE
Essential health benefits
CHANGE
OBAMACARE Requires all insurers to offer 10 categories of essential health benefits, like maternity treatment and hospital care.
Prohibitions on annual and lifetime limits
CHANGE
OBAMACARE Bars insurers from setting a limit on how much they have to pay to cover someone.
SENATE BILL Preserves this rule, but gives states the option to eliminate it as part of a waiver of insurance market rules.
Pre-existing conditions policy
KEEP
OBAMACARE Requires insurers to cover people regardless of pre-existing medical conditions and bars them from setting prices based on a person’s health history.
Restrictions on charging more for older Americans
CHANGE
OBAMACARE Bans insurers selling policies directly to individuals from charging their oldest customers more than three times what they charge their youngest ones.SENATE BILL Allows insurers to charge older customers five times as much as younger ones.
Individual mandate
REPEAL
OBAMACARE Requires all Americans to buy health insurance or pay a tax penalty, with exceptions for people who have experienced hardships.
Employer mandate
REPEAL
OBAMACARE Requires larger companies to provide affordable insurance to their employees, or face financial penalties.
SENATE BILL Eliminates the penalties.
Health savings account
CHANGE
OBAMACARE In 2017, allows an individual to put $3,400 and a family to put $6,750 into a tax-free health savings account.
SENATE BILL Allows people to put more money into their health savings accounts, up to the maximum allowed for out-of-pocket costs, and lets spouses make additional contributions.
Dependent coverage until 26
KEEP
OBAMACARE Allows children to stay on their parents’ insurance policies until age 26.
SENATE BILL Keeps this intact.
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