Republican Obamacare plan would repeal Medicaid expansion, taxes

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By Yasmeen Abutaleb

<span class="articleLocation”>Republicans in the U.S. House of Representatives
have unveiled a plan to replace Obamacare, known formally as the
Affordable Care Act, stripping away much of Democratic President
Barack Obama’s signature domestic policy achievement that
insured 20 million Americans.

President Donald Trump and his Republicans had vowed for
years to dismantle the law. It was a central campaign issue in
2016. Two House committees will next review the bill, so it
could still change substantially. Here are its main provisions:

TAXES

The Republicans want to eliminate next year Obamacare’s
income-based tax credits that help low-income people purchase
individual insurance. These would be replaced with age-based tax
credits ranging from $2,000 to $4,000 per year that would be
capped at upper income levels. While Obamacare’s credits
provided more assistance to those with lower incomes, those in
the Republican plan would be largely based on age.

The Republican bill would abolish most Obamacare taxes,
including taxes on medical devices, health insurance premiums,
indoor tanning salons, prescription medications and high-cost
employer-provided insurance known as “Cadillac” plans.

Those taxes paid for Obamacare. Republicans have not said
how they would pay for the parts of the law they want to keep.

The bill also repeals the Obamacare financial penalty for
the 2016 tax year for not purchasing insurance, as well as a
surtax on investment income earned by upper-income Americans.

And it repeals the mandate that larger employers must offer
insurance to their employees.

MEDICAID

Under Obamacare, more than 30 states, including several
Republican states, expanded the Medicaid government health
insurance program for the poor. About half of Obamacare
enrollees obtained insurance through the expansion.

The bill would allow the Medicaid expansion to continue
until January 1, 2020, providing states that chose not to expand
under Obamacare a window to enroll more people. After that date,
the expansion would end and Medicaid funding would be capped on
a per-person basis.

States that did not expand Medicaid would receive additional
funds through a number of changes, including the reinstatement
of disproportionate share hospital payments, money that is
provided to hospitals that serve a large number of Medicaid and
uninsured people.

State Medicaid plans would no longer have to cover the same
essential health benefits that health insurers on Obamacare’s
exchanges must provide. That fulfills a Republican promise to
return more control to the states, as they can decide what their
Medicaid plans must cover.

INSURANCE COVERAGE

The Republican plan would maintain some of Obamacare’s most
popular provisions. It would allow young people to stay on their
parents’ health plan until age 26, ban insurers from
discriminating against those with pre-existing conditions and
bans insurers from setting a lifetime dollar limit on coverage.

But the bill would allow insurers to mark up premiums by 30
percent for those who have a lapse in insurance coverage of
about two months or more.

Insurers won another provision they had long sought: The
ability to charge older Americans up to five times more than
young people. Under Obamacare, they could only charge up to
three times more. It would also allow states to set their own
ratio.

The measure also provides states with $100 billion to create
programs for patient populations, including high-risk pools to
provide insurance to the sickest patients.

The bill would also revoke federal funding for Planned
Parenthood for one year.



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