On Monday, Republicans in Congress finally unveiled their plan to replace the Affordable Care Act. Here's what you need to know about the new plan, which, FYI, they're calling the American Health Care Act.
Republicans are taking this opportunity to gut many provisions of the ACA that conservatives have been fighting since its inception.
The GOP plan removes one of the pillars of the ACA—the mandate for individual coverage. Under the new bill, people would no longer be directly penalized for not having coverage. (Under the ACA, uninsured individuals were hit with a tax penalty.) However, the new bill does allow insurers to impose a 30 percent surcharge on individuals who have gaps in their coverage, which effectively penalizes a lack of coverage as well.
In this case, however, since the penalty is only incurred when a person decides to become insured again, the penalty might actually discourage some individuals from seeking health insurance if they've experienced a lapse in coverage, unless they're already sick.
GOP Senator Rand Paul has taken issue with the AHCA, calling the bill a bailout for insurance companies. He specifically cited the 30 percent surcharge provision as an example of how he sees the new legislation as a bailout.
While the ACA also uses tax credits to help Americans offset the cost of insurance, the AHCA will change how these work in a significant way. Under the ACA, the tax credits are income-based, with the lowest earners enjoying the largest credits. Under the AHCA, however, income would be only a small factor in determining the amount of tax credits. The age of the individual in question would be far more important.
Although the credits increase as people get older, taken in conjunction with other aspects of the AHCA, this actually stands to disadvantage older Americans.
Under the ACA, insurance companies were only allowed to charge the oldest people on their plans a maximum of three times as much as they were charging the youngest (and generally healthiest) members. The AHCA removes this limitation, which will likely result in lower premiums for the young and higher and higher premiums for older people on the plans. If you're looking for more information, Vox has an excellent, in-depth breakdown of the changes to tax credits under the AHCA.
The ACA allowed 31 states to expand Medicaid access, which was previously limited to people in very narrow and specific categories. This allowed 11 million low-income adults to become covered. Under the AHCA, Medicaid expansion would freeze on January 1, 2020, at which time no new enrollees who meet the ACA standards for the program would be able to apply. This would be a huge blow to low-income Americans.
Another bizarre change to Medicaid coverage under the AHCA is a plan, detailed in six pages in the bill, to kick lottery winners out of the program.
Planned Parenthood funding
As expected, the AHCA would defund Planned Parenthood, making the organization ineligible for Medicaid reimbursements and federal family planning grants. It's worth noting that, because of the 1976 Hyde Amendment, Planned Parenthood already doesn't use federal funding for abortion services, meaning that 100 percent of these cuts will affect the organizations other services, like preventative care and screenings.
What's staying the same:
Although the AHCA stands to make many changes to Obamacare, some popular aspects remain intact.
One of Obamacare's most popular effects was blocking insurers from denying coverage or charging more for people with pre-existing conditions. It will remain under the AHCA, if passed.
Coverage for young adults under the age of 26
Likewise, the provision allowing children to remain on their parents' insurance until they're 26 is also included in the AHCA. These popular aspects of the ACA have been generally embraced by Republicans and Democrats alike.
More surprising is news that the AHCA will continue to require insurance plans to cover the full cost of birth control. The provision is supported by 60 percent of Americans, according to a January Associated Press-NORC poll, which helps explain why conservative lawmakers left it in tact in their plan to replace Obamacare.
What all this means for women specifically:
The biggest blow to women under the AHCA is the defunding of Planned Parenthood, which offers a wide range of healthcare services to 2.5 million women and men every year. Planned Parenthood currently receives about 40 percent of its operating budget from the federal government, with much of that money coming from reimbursements for primary and preventative care.
As BuzzFeed notes, the bill also includes a ban on federal money being used toward plans that cover abortions, which limits the plans available to individuals looking to take advantage of the AHCA's subsidies.
While it's great that the cost of birth control would still be covered for those with insurance under the AHCA, other aspects of the bill severely limit access to adequate healthcare (both reproductive and otherwise) for low-income women in a number of ways, including the defunding of Planned Parenthood and the planned freeze on Medicaid expansion.