The Senate’s Obamacare repeal bill, which touches all parts of the health care system and beyond, creates new sets of winners and losers. Here are a few:
The wealthy: The bill would strike Affordable Care Act taxes on high earners, particularly a levy on investment income that fell on married couples with more than $250,000 of adjusted gross income and single filers with more than $200,000 of adjusted gross income. It also nixes a Medicare Hospital Insurance tax on incomes above $250,000.
The young and healthy: The plan focuses on lowering premiums by allowing states to cut some of Obamacare’s major insurance rules that help protect sicker patients but also drive up the cost of coverage. For instance, states could cut mandated coverage of emergency care and substance abuse treatment. Younger and healthier people with fewer health care needs would be able to buy skimpier health insurance.
GOP governors who fought Obamacare: Republican governors who sought less federal oversight and more state control over their insurance markets will get tremendous leeway under waivers in the Senate bill. The Senate plan would roll back requirements about what insurers must cover and expedite state applications seeking more flexibility. For instance, governors would no longer need permission from their legislatures to obtain waivers.
Some health industry groups: Medical device makers, health insurers and tanning establishments, among others, would see the eventual elimination of ACA taxes on their products or services — although some of those taxes may be kept temporarily to pay for parts of the plan. Major provider groups, however, including the American Hospital Association, have come out forcefully against the Senate bill, while many other industry groups were still reviewing the plan Thursday afternoon.
Poorer, older insurance consumers: The Senate plan, like the House bill, would allow insurers to charge their older customers up to five times as much as younger customers for the same health plan. That’s an expansion of the so-called age band in Obamacare, which allows insurers to charge older customers no more than three times as much as younger ones. In two years, the Senate plan would also eliminate a key subsidy program that helps cover out-of-pocket medical bills for low-income consumers.
People struggling with addiction: The bill rolls back the federal government’s generous funding for Medicaid expansion, which has been a major source of substance abuse treatment amid the opioid epidemic. The Senate draft earmarks $2 billion for opioid treatment in 2018 — compared to the House’s provision of $15 billion over 10 years for mental health, substance abuse and maternity care. The Senate bill does loosen some restrictions on Medicaid funding of long-term treatment for people with substance abuse and mental health issues.
Planned Parenthood and its clients: The women’s health organization, a frequent GOP target for defunding, would be cut out of the Medicaid program for one year. However, this provision could be problematic for moderate Republican Sens. Susan Collins of Maine and Lisa Murkowski of Alaska, and Republicans can’t afford to lose more than two votes.
Public health agencies: The draft kills the ACA’s $1 billion Prevention and Public Health Fund in 2018, one year earlier than the House-approved health bill. The fund makes up roughly 12 percent of the Centers for Disease Control and Prevention’s budget and has been used to address public health threats, including the Zika virus outbreak, as well as for preventive health services and immunization programs.
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