WASHINGTON -- By rapidly approving a major overhaul of the 2010 health-care law known as Obamacare, House Republicans have raised questions among many voters on precisely what kind of coverage they will receive if the Senate approves the same version -- unlikely as that might be.
The nonpartisan Congressional Budget Office has not analyzed the latest House GOP bill. But in March, the office analyzed a similar measure and concluded the number of Americans without health insurance or government coverage would increase by 24 million by 2026.
About 155 million Americans are insured by their employers, 55 million are covered by Medicare, which pays health costs for the elderly, and another 74 million by Medicaid, the joint federal and state program that provides health care for low-income people and the disabled.
But until President Barack Obama signed the Affordable Care Act in 2010, roughly 46 million Americans were not covered, many of whom worked for small companies that do not insure their workers. Those are the people most impacted by the House GOP bill.
Obamacare cut the number of people without coverage by 40 percent in two ways.
Families of four earning between $34,000 and $98,400 a year can receive federal tax credits to buy individual insurance policies through the federal or state marketplaces, known as exchanges.
And the law expanded Medicaid eligibility. The federal government provided billions of dollars to the states to cover a family of four earning as much as $33,948 a year, which is 138 percent of the federal poverty level. Ohio Gov. John Kasich accepted the federal dollars to provide health coverage to more than 700,000 in Ohio, including many drug addicts and the mentally ill.
So let's check how the House Republican bill would impact you.
Question: Could a person without insurance still buy a plan in the exchanges?
Answer: Yes. The Republican plan keeps the exchanges but bases the refundable tax credit on a person's age as opposed to his or her income, as Obamacare does. For example, a person up to age 29 would receive a $2,000 credit while someone age 60 or older would be eligible for a $4,000 credit. A person between the age of 50 and 59 would be eligible for a $3,500 tax credit, a change from the original House bill.
Q: Does the House GOP bill provide fewer benefits for private plans?
A: Obamacare requires policies sold through the marketplaces to include 10 essential benefits, such as hospitalization, maternity and newborn care, prescription drugs and laboratory services. The House Republicans did not change that in the bill but made it possible for states to do so. Beginning in 2020, states can ask the federal government for permission to allow insurance companies to offer plans with fewer benefits.
Q: Why did the Republicans do that?
A: They argue that giving consumers more choices would increase competition. They say it would lower premiums by allowing insurance companies to cover fewer benefits. They contend healthy people would more likely buy policies that don't cost as much even if they offer fewer guaranteed benefits.
Q: Does the Republican plan guarantee -- as Obamacare does now -- that people with pre-existing conditions, such as high blood pressure, cancer or heart trouble, can buy health insurance?
A: Yes, but there is a catch. Under the Republican plan, states can ask to opt out of "community ratings," which require insurance companies in a particular geographic area to charge the same premiums to all people, no matter their health condition.
That means if someone lives in a state that receives a waiver and they have a lapse in coverage for more than 63 days, they could be charged higher premiums for one year to buy individual policies on the exchanges. States receiving a waiver would have to establish high-risk pools for people subject to higher premiums or a re-insurance program that hopefully would lower premiums. The House bill includes $138 billion during the next nine years to establish these programs.
Q: Are these good ideas?
A: Perhaps, but high-risk pools, which were established before Obamacare, have not worked well in the past, as premiums have still been expensive and long waits have been created for people to buy policies.
Q: Can my kids remain on my policy up to age 26, as under Obamacare?
Q: Are abortion services covered?
A: No. Under the GOP plan, the tax credits cannot be used to buy a plan that offers abortion services, except for procedures to protect the life of the woman, or in cases of rape or incest.
Q: Does Medicaid coverage change?
A: Yes. Starting in 2020, the federal government would cap federal Medicaid dollars available to states and eliminate the federal dollars Kasich has used to expand Medicaid in Ohio.
People who were part of the expanded program before 2020 would be grandfathered in, but those dropping out would not be allowed to return, meaning the number of those people on expanded Medicaid coverage would shrink. States could continue to provide expanded Medicaid coverage, but they would have to pick up more of the costs -- which in Ohio's case would amount to hundreds of millions of dollars a year. The bill prohibits Medicaid dollars from being paid to Planned Parenthood clinics.
Q: Is it true House Republicans cut taxes for the wealthy?
A: For the most part, yes. Congress approved a number of taxes in 2010 to finance Obamacare. As of next January, the House bill repeals investment taxes on married couples earning more than $250,000 a year, a Medicare surcharge on wealthier people, a 2.3 percent tax on companies' sale of medical devices, and higher taxes on pharmaceutical companies.
The bill scraps penalties on individuals who failed to buy an insurance policy (the so-called individual mandate) and repeals what has become known as the Cadillac tax, an assessment on expensive insurance plans offered by some employers. Overall, the bill would cut taxes by $765 billion during the next 10 years.