A new version of Trumpcare is set for a vote on Thursday. The House Republican leadership believes they have the votes needed to pass the bill. What exactly is in the bill? Does it actually repeal Obamacare? (Spoiler: it doesn't.)
Here are seven things you need to know about the new Trumpcare bill.
1. It defunds Planned Parenthood. Planned Parenthood would no longer receive Medicaid funding under the bill; instead $422 million will be reallocated to community health centers that provide women's health services minus the abortions.
2. States would be allowed to opt out of Obamacare's ban on lifetime limits and cap on out-of-pocket costs. States have the option to do this under the new Trumpcare bill's provision of letting states opt-out of mandated essential health benefits. This has been portrayed as a move that would harm employer-sponsored health insurance, but these regulations imposed by Obamacare have increased costs: if there are no limits on health care spending and caps on out-of-pocket costs, that means higher costs to insurers that they pass off through higher premiums. Health care policy wonk Avik Roy explained in 2013:
These mandates have already had drastic effects on a number of colleges and universities, which offer inexpensive, defined-cap plans to their healthy, youthful students. Premiums at Lenoir-Rhyne University in Hickory, N.C., for example, rose from $245 per student in 2011-2012 to between $2,507 in 2012-2013, forcing the school to drop its coverage requirements. The University of Puget Sound paid $165 per student in 2011-2012; their rates rose to between $1,500 and $2,000 for 2012-2013.
3. The individual mandate will be repealed.
4. States have the ability to charge people with pre-existing conditions higher premiums. But the bill still provides protections for those with pre-existing conditions, as Ramesh Ponnuru explains in National Review:
States would be able to waive Obamacare rules on preexisting conditions only for people who do not maintain insurance coverage. If you are someone with one of those conditions who has gotten coverage through Obamacare (or otherwise gotten coverage), the Obamacare regulations will still apply: In no state will it be possible for an insurance company to charge you more than a person without such a condition. If you are someone who has insurance and develops one of these conditions, you too will be covered by the Obamacare regulations. Insurers will not be able to charge you extra, either, under any waiver.
And maintaining insurance coverage will be easier than it was pre-Obamacare, because people without access to Medicare, Medicaid, or employer coverage will have a tax credit to purchase insurance on the individual market.
So the only people who might be adversely affected by a waiver of the Obamacare rules — if a state applied for one — would be those who have a preexisting condition but have not used their credit to buy insurance. And even they would have to have access to a high-risk pool for the regulations to be waived.
People with preexisting conditions, then, would have a triple safety net even in a state that took maximum use of the waivers: Tax credits, regulatory protection contingent on continuous coverage, and high-risk pools would all benefit them.
An amendment that pays people not to buy insurance if they're healthy was also introduced to woo over moderate-to-liberal Republicans. While that would offer more protection toward those with pre-existing conditions, it would only exacerbate the death spiral.
5. Medicaid expansion would end by 2020. Medicaid would then be block-granted to the states on a per capita basis. While block-granting Medicaid is a crucial move to bring down healthcare costs, the fact that the Medicaid expansion will remain in place until 2020 will cause a bull run of people who are eligible for the program to sign up before the expansion freezes in 2020, which would further bankrupt the system.
6. Older enrollees can be charged five times as much as younger enrollees. This is a holdover from the March iteration of Trumpcare; Erick Erickson noted at the time that the provision "will price a large number of seniors out of the insurance market."
7. Congress will be exempt from Trumpcare. A bill has been proposed to fix this, but it remains to be seen if the House will pass it or not.
H/T: USA Today