The American Health Care Act (AHCA), also known as Trumpcare, was narrowly passed through the House of Representatives on Thursday May 4th. On Thursday June 22nd, after a secretive seven-week revision process led by Majority Leader Mitch McConnell, a draft of the Senate version of the bill has been released. Following is a comparison of some of the important changes between the ACA (Obamacare) and both versions of the AHCA.
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ACA |
AHCA (House version) |
AHCA (Senate version) |
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Medicaid continues to expand. Medicaid expansion has paid almost all of the cost of adding 11 million Americans to the program in 31 states.[1] |
Medicaid expansion rolled back over the next ten years. |
Medicaid expansion phased out over 3 years beginning in 2020. |
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According to the CBO score, 28 million people uninsured by 2026. |
According to the CBO score, 51 million people uninsured by 2026. |
According to the CBO score, 49 million people uninsured by 2026. |
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Uninsured individuals receive a tax penalty. |
Insurance companies charge a 30% surcharge for previously uninsured individuals seeking insurance. |
Individuals without coverage for longer than around two months barred from purchasing insurance on the individual market for six months. |
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Beneficiaries cannot be denied services for a pre-existing condition, and insurance companies cannot charge people differently based on their health. |
Beneficiaries cannot be denied services for a pre-existing condition, but states can decide whether insurance companies would be able to increase rates for these beneficiaries. |
Beneficiaries cannot be denied services for a pre-existing condition, and states are not allowed to opt out of banning insurers from charging people based on health. But, insurers may provide less coverage in states that get waivers for essential health benefits. |
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Tax subsidies help people at lowest income levels pay for insurance. |
Subsidies repealed and replaced by tax credit system providing individuals $2,000 - $4,000 per year based on age, for people making up to 400% of the federal poverty line (less generous than existing ACA credits). Amount of covered expenses reduced as recipients get older. |
Subsidies distributed similarly to ACA through 2019, but eligibility for premium tax credits cut for anyone earning more than 350% of the poverty line. |
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Provides funding and reimbursements to Planned Parenthood, excepting abortion services. |
Blocks all federal funds from going to Planned Parenthood for one year. |
Blocks all federal funds from going to Planned Parenthood for one year. |
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Adult children up to age 26 may stay on their parents’ insurance plan. |
Adult children up to age 26 may stay on their parents’ insurance plan. |
Adult children up to age 26 may stay on their parents’ insurance plan. |
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Certain essential health benefits are guaranteed. |
States may redefine what qualifies as an essential health benefit. |
States may redefine what qualifies as an essential health benefit. |
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Requires larger employers to provide affordable coverage. |
Repeals ACA provision requiring larger employers to provide affordable coverage. |
Repeals ACA provision requiring larger employers to provide affordable coverage. |
In order for the Affordable Care Act to be officially replaced by the American Healthcare Act, the bill still needs to pass through the Senate and the scrutiny of the Senate parliamentarian. The Senate Parliamentarian, Elizabeth MacDonough, will ultimately decide if the bill counts as a reconciliation bill. If it does, then only 51 votes are required to have the bill pass through Senate. Otherwise, it will require 60 votes, an unlikely scenario as it would require Senate Democrats to vote favorably. The bill was to be voted on before the Senate’s 4th of July recess, but due to insufficient support it will be revised and voted on after the recess.
