Replacing the Affordable Care Act - | WBTV Charlotte

Replacing the Affordable Care Act

(Source: WBTV/File) (Source: WBTV/File)
WASHINGTON (WBTV/AP) -

While much is still unknown about the cost and coverage under the GOP-backed proposed health care law, critics are not waiting to push back against the possible Obamacare replacement.

Near uptown Tuesday morning, a small group of local healthcare advocates aligned themselves with the “Save Our Care” national tour and spoke out against the overhaul.

County Commissioner Trevor Fuller, a Democrat, said there’s little about the proposed bill he can support.

"We must not destroy the ACA. We can improve it,” said Fuller about the Affordable Care Act. “When we talk costs about the of healthcare, it's very real for us in the County,” he said expressing concern that if fewer people are covered under the GOP plan, the burden will shift to states and local governments to fill the gap.

Don Jonas, executive director of Care Ring, which serves nearly 7,000 working poor and very poor people in our area says their agency is not prepared to help an influx of new clients. 

“They have difficulty accessing food. Difficulty with transportation, jobs, all kinds of challenges in their life. To suddenly become experts at what might be the best health insurance plan … these are extraordinarily difficult decisions to make, especially for a consumer who has no history of doing this kind of work,” said Jonas.

At first glance, the new health care bill from House Republicans appears to have similarities to the Obama-era law, like tax credits, protections for people with health problems, and the ability of parents to keep young adults on their insurance.

But in most cases, those components would work very differently under the GOP framework than is currently the case with the Affordable Care Act, or Obamacare.

Key details about the Republican plan are still unknown, including cost and coverage. Here's a comparison between Obama's ACA, which is current law, and the GOP's bill:

COST

Current law: Coverage costs of about $1.4 trillion from 2017-2026, based on Congressional Budget Office estimates.

GOP bill: Unknown at this time; Republican aides say CBO numbers are coming shortly.

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MEDICAID

Current law: Medicaid is now the country's largest health insurance program, covering more than 70 million people under a federal-state collaboration. It remains an open-ended entitlement, allowing states to draw down federal money for a portion of health costs incurred by low-income people, from children to nursing home residents.

GOP bill: Ends the higher federal match for Medicaid expansion beneficiaries, starting in 2020. States can still continue to receive some enhanced federal payments, but only for expansion enrollees who were already covered before that. States will get a lower match for new enrollees.

But more significantly, the bill would overhaul the framework of Medicaid, ending its open-ended federal financing. Starting with the 2020 fiscal year, each state would receive a limited, per-beneficiary amount based on enrollment and costs. States would gain flexibility to cap enrollment and change benefits. Federal payments would be increased according to a measure of medical inflation. Impacts are unclear.

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PRIVATE COVERAGE FOR INDIVIDUALS

Current law: Provides income-based tax credits for consumers buying government-regulated plans through HealthCare.gov and state insurance markets. The most generous assistance goes to people with low-to-modest incomes. Many solid middle-class households get no help despite sharp increases in premiums.

GOP bill: Provides tax credits primarily based on age, gradually phasing down for individuals making over $75,000, or married couples earning more than $150,000. Credits can be used to buy any state-licensed health plan. More middle-class consumers will benefit, but there's concern lower-income people would be disadvantaged.

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DEDUCTIBLES

Current law: Provides cost-sharing subsidies for low-to-moderate income people who buy a standard silver plan in the government markets.

GOP bill: Eliminates ACA's cost-sharing subsidies, but allows people to make much higher contributions to tax-sheltered health savings accounts, to cover deductibles and copayments. Sets up a fund that states can use for a variety of purposes, including cost-sharing assistance.

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PRE-EXISTING CONDITIONS

Current law: Forbids insurers from turning people down on account of medical problems, or charging them more.

GOP bill: Provides protection for people with health problems. But consumers who have not maintained continuous insurance coverage face a 30 percent premium penalty for a year. States can use federal funds to set up high-risk pools as insurers of last result.

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GENERATIONAL BALANCE

Current law: Insurers can charge their oldest customers no more than 3 times what they charge young adults. That benefits older adults prone to illness but has made coverage costly for young people.

GOP bill: Insurers could charge older customers up to 5 times what they charge young adults. Advocates for older people complain that's unfair.

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YOUNG ADULTS

Current law: Can stay on parental insurance until age 26.

GOP bill: Same.

Expect several changes and revisions as the bill makes its way through Congress and eventually, to the President’s desk.

Copyright 2017 WBTV. The Associated Press contributed to this report. All rights reserved.

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