If you've been anywhere except under a rock, you've heard about how the House passed President Trump's healthcare bill, effectively dismantling the ACA. People on the left and the right have very strong opinions about it - it's hard to hear about anything else. But do you really know what they've talking about? Who's right? Who's too biased to care if they're right? What is healthcare, anyway? Well, I can't help you much on the last one, but here's a shortened version of the AHCA, what's in it, what's not, and how it affects the American public. (Information is taken from NPR unless otherwise noted; NPR is a fairly reputable source and one of the least skewed sources available. Here's the full text of the bill, in case you're interested. Warning: It's dense.)

Buying Insurance

Under the AHCA, people would no longer have to buy in the ACA marketplace if they want to use federal tax credits. The tax penalty for not having insurance would also be eliminated. Instead, if coverage is interrupted for longer than 63 days, the insurance company can charge the person a 30% penalty over their premium for a year. And under the AHCA, you can still stay on your parents' plan until you're 26, so breathe a sigh of relief.

Tax Credits

Instead of being based on income, tax credits and subsidies under the AHCA would be age-based. Overall, older people with lower incomes will see a big increase in the cost of their health insurance, while younger people will see changes based on their location. (The example NPR used was that someone in Kansas might see their cost go up, while someone in Washington state at the same age might see theirs go down. This map is a great tool to see how this could affect people across the country based on age, income, and location.)

Tax Cuts

The AHCA would eliminate almost all the taxes in the ACA that were used to pay for the subsidies to help people buy insurance; this is likely why costs would be driven up for many demographics (speculation my own). These cuts would add up to about $592 billion. The taxes being cut would be a tax on incomes over $200,000 (or $250,000 for a married couple) a tax on insurance companies (and a limit on how much the companies can deduct to pay their executives), and a tax on medical-device manufacturers.

Medicaid

Medicaid would be totally overhauled under the AHCA. Currently, under the ACA, states can expand Medicaid eligibility to single, non disabled adults with incomes slightly above the poverty line; around 10 million people are enrolled under that expansion. People are constantly cycling in and out of this program as their income fluctuates; the AHCA would rule that once someone exited this program, they could not come back unless they were under the poverty line. This would lead to an ever-decreasing number of people covered, starting in 2019. The bill also converts Medicaid from an entitlement program (where the government pays all the health-related costs for those who qualify) to a grant program (where the government would give states either a set amount of money for each person enrolled in Medicaid or let them choose to receive a fixed-dollar block grant). It is estimated that this would cut Medicaid spending by about $880 million.

Pre-Existing Conditions

The big one! Contrary to what you've probably seen on the news and online, the AHCA maintains protections for those with pre-existing conditions; this means that someone with high medical expenses would pay the same premium as anyone else in their age category.

The problem comes in with the waivers.

State Waivers

There is a section of the AHCA that allows states to choose a full repeal of the ACA. These waivers give states the ability to do one of three things: charge older people more than five times what they charge young people for comparable policies, eliminate essential health benefits (including maternity care, mental health and prescription drugs), and charge more or deny coverage to people who have pre-existing conditions. If a state doesn't choose the waiver option, all pre-existing conditions are covered, just like under the ACA. If they do? That's a different story.

It has been circulating the rape and domestic abuse are considered pre-existing conditions. By themselves, this is false, but their lasting emotional effects can be considered pre-existing conditions if treatment is sought (and any STDs or physical injuries sustained). Cancer, diabetes, and arthritis are also considered pre-existing conditions.

States with waivers would very likely see insurance companies offer many more policy options, some with fewer benefits and lower premiums. Those states would also be required under law to create some other way to ensure that people with expensive illnesses are able to get health care, and the law provides up to $138 billion over 10 years for such programs (high-risk pools). However, an analysis by consulting firm Avalere Health concludes that that amount would be inadequate for providing full health coverage for the number of people who now buy insurance in the individual market and have medical problems.

Conclusion

The House approved the bill (narrowly), and the AHCA awaits a Senate vote. But experts say that bill won't pass through the Senate without a major overhaul first.

A full Congressional Budget Office, or CBO, analysis has not been completed yet (a huge red flag - generally no votes are taken on a bill without a CBO cost estimate), but a preliminary report from March found that over 10 years, 24 million less people would be covered under the AHCA than the ACA. That analysis also found that the AHCA would cut federal deficits by $337 billion over those same 10 years. This cut in the deficit is likely due to the fact that less people would be covered.

The AHCA would likely have a minimal effect on most young, middle class people with no major health problems. Older Americans with a low income or those with major health problems, on the other hand, would feel the effect of the AHCA - but only if their states opted for the waivers.

So there you have it, now you can discuss healthcare with the best of 'em!