Clarifying health reform: Comparing the federal proposals to the ACA

 

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By Dustyn Jones

Healthcare in the United States is a quandary.  Individuals of all socioeconomic classes require access to necessary, quality healthcare services and supplies, and the money to pay for them always seems to come up short.

Combine that with a government that seems to be operating lately more like three siblings in the back seat on a road trip than the leaders of the free world, and you find yourself in the United States healthcare battle of 2017.

If you have been living under a rock and/or avoiding television and social media, our government is having a slight disagreement regarding how to remedy the healthcare situation.  In the 2016 presidential election, the Republican platform centered largely on “repealing and replacing” Obamacare.

Fast forward to June 2017 and we have a competition between the existing Patient Protection and Affordable Care Act (the ACA), the House Republicans’ American Health Care Act (AHCA), and the Senate Republicans’ Better Care Reconciliation Act of 2017.  Below are the salient differences between the three.

Individual Mandate

ACA:  Requires United States citizens and their dependents to carry minimum essential health coverage.  Failure to maintain coverage results in a tax penalty.

AHCA:  Repealed tax penalty for failure to maintain minimum essential health coverage effective January 1, 2016.  Instead, imposes a 30 percent late-enrollment surcharge if an insurance applicant goes longer than 63 days without continuous health insurance coverage.  The surcharge is discontinued after 12 months of consecutive coverage.

BCRA:  Does not include an individual mandate.

Premium Subsidies to Individuals

ACA:  Provides premium tax credits to qualified individuals with incomes between 100 percent and 400 percent of the Federal Poverty Level and who purchased coverage on the federal- or state-operated insurance exchanges.

AHCA:  Provides premium tax credits to everyone.

BCRA:  Provides premium tax credits to qualified individuals with incomes below 350 percent of the Federal Poverty Level.

Essential Health Benefits

ACA:  Requires ten essential health benefits.

AHCA:  States can apply for waivers to eliminate essential health benefits, but if the waiver is granted, the new benefits package only applies to individuals who did not maintain continuous health coverage.

BCRA:  States can apply for waivers to eliminate essential health benefits.

Pre-Existing Conditions

ACA:  Health benefit plans cannot charge individuals with pre-existing medical conditions higher premiums.

AHCA:  States can apply for waivers to charge individuals with pre-existing medical conditions higher premiums, but if the waiver is granted, the new benefits package only applies to individuals who did not maintain continuous health coverage.

BCRA:  Health benefit plans cannot charge individuals with pre-existing medical conditions higher premiums.

Medicaid Expansion

ACA:  Expanded Medicaid eligibility to adults with incomes up to 138 percent of the Federal Poverty Level.  Federal matching at 95 percent in 2017, 94 percent in 2018, 93 percent in 2019, and 90 percent in 2020 and thereafter.

AHCA:  Freezes the ACA’s Medicaid Expansion effective January 1, 2020.

BCRA:  Rolls back Federal matching to 85 percent in 2021, 80 percent in 2022, 75 percent in 2023 and the general state match percentage after 2023.

-Dustyn Jones is an attorney with Stites & Harbison in Louisville, Ky.

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