Summary of Republican Congressional Health Reform Proposal
Steffie Woolhandler, M.D., M.P.H., & David Himmelstein, M.D.
Most ACA insurance regulations unchanged (probably can’t be changed through reconciliation)
- Cover preexisting conditions
- No health status underwriting
- Meet actuarial value requirements
- Cover adult children up to age 26
- Cap out-of-pocket expenditures
- No lifetime or annual limits
- 10 essential benefits
Medicaid – Cuts in Federal payments estimated at $370 billion/10 years
- Ends ACA expansion and essential health benefit requirements 1/1/2020
- Replaces Federal Medicaid match with per-enrollee funding 1/1/20.
- Full funding for those continually enrolled since 1/1/2020; reduces funding for new enrollees or re- enrollees by one third.
Federal payments to the states through Medicaid or any other program for Planned Parenthood would be prohibited
Insurance Regulation and Continuous Coverage Requirement
- Replaces mandate with continuous coverage requirement for individual/small group plans: Premiums increased by 30 percent for those with a gap in creditable coverage of at least 63 continuous days during the preceding 12 months (or, for people leaving dependent coverage, who did not enroll during the first available open enrollment period).
- Allows premiums to vary by a 5:1 ratio for old:young (vs. 3:1 under the ACA)
Coverage subsidies (tax credits)
Replace ACA subsidies with age-adjusted, fixed-dollar advanceable tax credit. Phased out for individuals with income > $75,000 (families > $150,000)o $2,000 for individuals under 30
- $2,500 for those ages 30 to 40;
- $3,000 for those ages 40 to 50;
- $3,500 for those ages 50 to 60; and
- $4,000 for those over 60 (<1/3 of the average cost of coverage for this age group)
- Tax credits would only be available for individuals not eligible for employer coverage
- Most non-citizens ineligible for tax credits
- Prohibit using subsidies for any plan that covers abortions
Taxes repealed & new cuts (amounts in parentheses are amounts lost to treasury over 10 years)
- Medicare tax on unearned income for wealthiest 2% of taxpayers ($157.6 billion).
- Medicare surtax on high incomes >$200,000 ($117 billion)
- Tax on prescription drug firms ($24.8 billion).
- Tax on medical device firms ($19.6 billion).
- Tax on health insurers ($144.7 billion).
- Tax on health insurer executive compensation exceeding $500k ($400 million)
- Others: Tanning tax ($600 million);.med. expense deductions ($34.9 billion); FSAs ($18.6 billion); HSAs ($24.1 billion);
- Delays Cadillac tax
- Cuts $1 billion from Prevention and Public Health Fund (i.e. CDC and public health departments).
- $100 billion in new funds for states to establish high risk pools etc.