One of Donald Trump’s biggest campaign promises was that he would repeal and replace Obamacare. After a lot of time drafting a proposal, the Senate has come up with a plan to propose.
Our former President Barack Obama is clearly unhappy with the new bill proposal, and he stated on Facebook that instead of the replacement being a healthcare bill, it is “a massive transfer of wealth from middle-class and poor families to the richest people in America.”
One of the major ways the Senate bill differs from the House bill is that in this proposal states can’t get rid of rules that would ban insurance companies from charging higher prices to people with a pre-existing condition.
After unveiling the proposal on Thursday, five Senate Republicans said they would vote no by Friday. These Senate members were Ted Cruz, Rand Paul, Mike Lee, Dean Heller and Brian Sandoval. Now, they are up to nine Senators who say they will vote no.
At a press conference, with Sandoval in attendance, Heller said, "I cannot support a bill that takes insurance away from tens of millions of Americans and hundreds of thousands of Nevadans.”
The potential changes to our current healthcare system have been a very controversial topic, and even after revisions from the House to the Senate, people who believe healthcare is a right will view this bill as a major setback. In this comparison, you can see the technical aspects of the proposals that have been set forth and our current system with Obamacare.
1. MEDICAID
Obamacare: States have the option to expand Medicaid to cover more low-income adults. The federal government picks up no less than 90 percent. Medicaid covers around 70 million people of all ages.
House GOP Bill: The amount of money given to Medicaid is determined through states, and then matched by the federal government. So, this change would cut how much the federal government will give to match the states.
Senate GOP Bill: The intent of the Medicaid expansion was to include another group of adults, and include more people. This change would phase out who will receive Medicaid, and how much they would receive. The CBO also estimated that with the new Senate GOP Bill by 2026, how much is spent on a national level would be $772 billion less than it would be if Obamacare remained in place.
2. PRE-EXISTING CONDITIONS
Obamacare: People cannot be denied coverage because of pre-existing medical problems, and they also can’t be charged more if they have bad health.
House GOP Bill: Consumers need to be sure they don’t drop their insurance for more than 63 days or else they’ll have to pay a penalty.
Senate GOP Bill: There wouldn’t be a penalty for having a break in coverage, and states wouldn’t be able to look for waivers to charge more based on a consumer's health.
Both the House and Senate proposed bills had a similar feature in which states had a way where they could opt out of covering the essential health benefits package, which is big in Obamacare.
3. SUBSIDIES FOR PRIVATE INSURANCE
Obamacare: This plan gives two kinds of subsidies for people without on the job coverage. Income-based subsidies will help with any premiums or out of pocket costs. Out of pocket costs could include deductibles and co-payments.
House GOP Bill: Premium subsidies are keyed to age, not income. Ends cost-sharing subsidies in 2020, while failing to clear up uncertainty about whether they can be paid currently.
Senate GOP Bill: Premium subsidies are keyed to income, age and geography, and are more tightly focused on lower-income people. But the benchmark for subsidies would be a bare-bones "Bronze" plan. Cost-sharing subsidies are explicitly extended through 2019, an important detail that should help calm insurance markets.
4. AGE FACTOR
Obamacare: An insurer can’t charge older customers more than 3 times what young adults are charged.
House GOP Bill: An insurer would be able to charge older adults up to 5 times more than they charge young adults.
Senate GOP Bill: This essentially follows what the House put forward.
5. MANDATES TO CARRY HEALTH INSURANCE
Obamacare: Those who can afford coverage need to have a policy or the IRS could fine them. Obamacare also requires that larger company employers offer coverage for all of their full-time workers.
House GOP Bill: The change the house would make would be to take away coverage mandates.
Senate GOP Bill: The Senate feels the same as the House and proposes the same plan.
6. STANDARD HEALTH BENEFITS
Obamacare: Requires all insurance plans to cover the most essential services, which include hospitalization, office visits, prescriptions, maternity/childbirth, substance abuse treatment, rehabilitation, and preventive services. These preventative services include birth control for women, without an additional charge.
House GOP Bill: Gives states the right to seek out a waiver from the benefit requirements.
Senate GOP Bill: This bill proposes the same as the House.
7. OPIOID EPIDEMIC
Obamacare: The expansion of Medicaid enabled a lot of states to provide treatment to people who are caught up in the opioid epidemic.
House GOP Bill: This proposed bill doesn’t offer extra money for the opioid epidemic.
Senate GOP Bill: They propose a two billion dollar fund for grants to states to help with substance abuse and mental health treatments.
8. TAXES
Obamacare: Obamacare raised taxes for wealthier people and for healthcare companies, to help finance the coverage expansion.
House GOP Bill: This proposal would cut taxes by almost $1 trillion over the next decade. These cuts would mostly be for larger corporations and richer families.
Senate GOP Bill: Tax cuts very similar to House bill, though some would be delayed.
9. ABORTION
Obamacare: Private health insurance plans for people who get federal assistance can cover abortion fees. But, they need to collect private funds that don’t come from taxpayers.
House GOP Bill: Takes away any abortion coverage for people insured by private health insurance plans, who also get federal assistance. This proposal would also defund Planned Parenthood.
Senate GOP Bill: This plan would also forbid abortion coverage for people with federal assistance, and would defund Planned Parenthood. There is a chance that abortion restrictions on private health insurance plans could be denied. But Senate leaders have a plan. Billions of dollar for stabilizing health insurance markets would be put through the Children’s Health Insurance Program. This program already has strong limits on funding abortions, so their idea is that insurers who need access to this fund would basically need to drop abortion coverage.
The Senate Republicans need 50 out of 52 members to vote yes on their bill, or receive a tie-breaker from VP Mike Pence, to pass this bill. They then will need to get the House on board before the bill will ever see the inside of President Trump’s office. But, these are the proposed changes to our current healthcare system. The Senate will be voting on these changes at some point in this upcoming week to see what the future of Obamacare, and health insurance in general, will hold.