Who Is covered

Under the ACA, the individual mandate requires that most Americans have health insurance coverage or pay a fine.  Under the Senate bill proposal, the individual mandate would be eliminated and there would not be any replacement to incentivize that healthy people purchase insurance.  Similarly, the employer mandate in the ACA requires that larger companies offer affordable coverage to their employees.  The Senate replacement bill eliminates the employer mandate.

How coverage would be paid for

Under the ACA, the federal government provides health insurance subsidies that help individuals afford coverage through the marketplace.   These subsidies were primarily based on income, age, and geography, which benefits lower- and moderate-income people. Under the Senate’s proposal, these subsidies would change and according to most experts, health care would become substantially less affordable, especially for those who are poor, unhealthy, or old.

The tax credits under the proposal would still be based primarily on age, income, and geography but would be made to cover a less robust plan.  Additionally, people would have to be lower-income to qualify than under the ACA.  Under the ACA, cost-sharing subsidies were provided to insurers to help some customers cover deductibles and copayments but under the Senate plan, these subsidies would end at the latest at the end of 2020.

Medicaid

Under the current system, Medicaid is an entitlement program which guarantees open-ended matching funds for anyone who qualifies.  Under the Senate bill, Medicaid would be funded by providing states with a per capita amount, or block grant, based on how much each state is currently spending, not adjusting for rising costs, starting in 2021.  According to the Congressional Budget Office’s (CBO) report on the House bill, this is expected to substantially decrease federal funding of Medicaid and therefore, decrease the funds that states have to spend on the program.  Additionally, for those states that expand Medicaid, the federal government would pay a smaller portion of the cost of expansion starting in 2021.

Prevention and Public Health Fund

The Senate bill would eliminate the Prevention Fund, starting fiscal year (FY) 2018, which begins October 2017.  This would result in a 12 percent cut to the Centers for Disease Control and Prevention (CDC) funding with deep impacts for health departments and others who depend on this funding to conduct core public health activities.

Essential Health Benefits

Under the ACA, insurers are required by the federal government to cover a certain, minimum set of “essential” health benefits, including care such as hospital visits and mental health care.  Under the Senate proposal, states would be permitted to change what qualifies as an essential health benefit.

Planned Parenthood

Under the Senate’s proposed bill, Planned Parenthood would face a one-year Medicaid funding freeze.

The full text of the bill can be found here, and a summary of the legislation may be found here.

A vote on the bill is being planned for the end of next week.  If the bill passed the Senate, it would need to be reconciled with the House version before going to President Trump for a signature.

NCSD has major concerns with this legislation, particularly regarding the number of individuals who will no longer have access to insurance– particularly Medicaid– and the elimination of the Prevention and Public Health fund beginning this year.   NCSD is working through a number of coalitions to oppose this legislation, including sending press releases, and participating in Hill visits.  Additionally, we joined a number of colleague organizations in placing an ad in a Capitol Hill Newspaper opposing rolling back ACA protections for vulnerable Americans, including those living with HIV.