American Health Care Act: Who wins and loses in the GOP's Obamacare replacement


In the wake of the House GOP's unveiling of the American Health Care Act -- proposed legislation they hope will overhaul former President Barack Obama's signature Affordable Care Act, health care experts are now weighing in on who wins and loses in the self-proclaimed replacement to "Obamacare."

On behalf of the Trump administration, Health and Human Services Secretary Tom Price tweeted his letter of support on Tuesday morning to congressional committee chairmen, in which he said the new American Health Care Act (AHCA) aligns with President Trump's goal of "rescuing Americans from the failures of the Affordable Care Act."

According to a new S&P Global ratings report, though, as much as 10 million Americans could lose their health insurance under the AHCA.

Comparing and contrasting multiple points of research, here is a sampling of those who could end up "winners" and "losers" if the current draft of the American Health Care Act becomes law.

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Winner: Young Americans

First, the AHCA keeps the Affordable Care Act (ACA) element that allows parents to keep young adults as old as 26 on their insurance plan.

According to CNN Money, younger Americans would also see their annual premiums go down. The ACA put levers in place that meant younger policyholders were subsidizing older ones. This would change under the AHCA, because the bill gives insurers the ability to charge elderly at a higher rate. According to a Milliman study for the AARP, Americans age 20 to 29 could save anywhere from $700 a year to $4,000, on average.

Loser: Elderly Americans

As was previously stated above, the AHCA allows insurers to charge older policyholders at a higher rate. (With the ACA, insurers were limited to charging those in their 50s and 60s a maximum three times what they charge younger policyholders.) With the AHCA, CNN Money reports that gap would be widened five-to-one.

According to a Kaiser study, a reduction in tax credits under the AHCA means an average 60-year-old making $50,000 a year in Lamb County, Texas would see a 51 percent decrease in their federal tax refund from $8,240 to $4,000.

According to a Milliman study, adults ages 60 to 64 would see their annual premiums jump 22 percent, or nearly $3,200, to nearly $18,000.

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Winner: Healthy people

Policyholders under age 30 were able under the ACA to buy plans with lower monthly premiums and higher deductibles called "catastrophic plans." Enrollees, however, were unable to use subsidies to pay the premiums.

The AHCA would change this, allowing anyone to enroll in a "catastrophic" plan -- and introducing tax credits as a means to pay the premium.

Loser: Anyone who benefits from Medicaid

About 70 million Americans are currently covered with health insurance through the Medicaid program. More than 11 million alone gained coverage after the ACA went into effect.

"It's not hyperbole to say this bill ends the Medicaid program as we know it," said Aviva Aron-Dine of the Center for Budget and Policy Priorities, and the former senior counselor to former Health and Human Services Secretary Sylvia Mathews Burwell.

As POLITICO's Dan Diamond writes, "The bill would cut back funding for states to pay for the ACA's Medicaid expansion, shifting from open-ended federal matching payments to per capita lump sum payments that would likely force governors to shrink the size of their programs."

Medicaid helps many lower-income people and families, and MIT economist Jonathan Gruber says of the AHCA there is "really no point to this effort" because of the way it burdens that demographic of policyholder.

"There's really no point to this effort," Gruber said to NPR on Wednesday morning. "It cuts help for the poor by replacing income-based tax credits — which make health insurance affordable — with flat tax credits, which make health insurance unaffordable."

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Winner: Higher-income people

The ACA included two specific taxes that were imposed on wealthier policyholders, which experts say was to help pay for the law. The AHCA includes many changes to the tax code, and would eliminate both of these taxes.

According to the Tax Policy Center, "Nearly all families affected by the additional payroll and investment taxes are in the top 5 percent of income, with most of the burden borne by families in the top 1 percent of income." According to a Joint Tax Committee study, removing these two tax credits would cost $275 billion over ten years.

The AHCA would also allow a higher contribution allotment in Health Savings Accounts, which are primarily used by policyholders who can afford to save money specifically for health care.

Loser: Planned Parenthood

The AHCA would federally defund Planned Parenthood for one fiscal year. The White House reportedly offered Planned Parenthood an opportunity to keep their funding if they stopped offering abortions as part of their services. Planned Parenthood then reportedly rejected this proposition.

Winner: Insurance companies

The bill does strike down the ACA's individual mandate -- which will likely spur a dip in enrollment -- but one of the biggest differences between the ACA and AHCA is the 30 percent surcharge on policyholders who fail to keep up continuous coverage. Also, where the ACA allowed insurance companies to deduct a max $500,000 of their executives' pay as a business expense, the AHCA would repeal that capped amount starting in 2018.

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