Differences among Obamacare and Trumpcare (House and Senate Versions)

As of Monday, June 26, Senate Leadership is continuing to tweak their Healthcare Bill to make it more palatable to their membership.  A new provision in the bill would encourage people to maintain continuous coverage by imposing a six-month waiting period before new insurance goes into effect for anyone with a break in coverage that lasted 63 days or more in the prior year.

There is a lot of confusion and varying explanations of how healthcare insurance will change over the next few months and years.  Here are some of the ways the three plans handle health care coverage:

Medicaid

One of the biggest changes in both the House and Senate Bills are in the area of Medicaid.  Under Obamacare, the states share the cost of insuring the poor with the federal government.  The federal government gives states different amounts based on the medical care that the state’s Medicaid patients receive. While 20 states opted out of Medicaid expansion, the federal government is picking up most of the costs of expanding Medicaid to the thirty states that have opted to expand Medicaid programs.

The House Bill would offer a fixed per capita amount to each state. This amount would increase based on inflation until 2020, when the increases would be eliminated.

The Senate Bill also replaces Medicaid with a block grant; however, the annual increase, based on inflation, and would be lower than the House Bill (meaning deeper cuts).  Instead of the expansion being eliminated in 2020, it would be phased out beginning in 2020 and eliminated by 2024.

Insurance Costs

Both the House and Senate plans would probably see lower insurance premiums after 2020; however, those plans will most likely cover less and have higher deductibles.

Under the Affordable Care Act (Obamacare) people making less than $48,000 a year received subsidies to help them buy insurance.  The subsidies reduce monthly insurance bills. They are tied to income and the cost of insurance within specific areas of the country.

The House Bill also provides for subsidies, which would phase out when incomes reach $75,000 a year.  The subsidies would be tied to a person’s age, not income.

The Senate Bill links aid to income, but stops at 350% of the poverty level, compared with 400% under Obamacare.  The subsidies would be based on less comprehensive health plans, which would mean substantially less assistance than under the current law.

Mandate

The Affordable Care Act levies a tax penalty on people deciding not to purchase health insurance.

Neither the Senate nor the House Bill keeps the mandate. However, under the House Bill anyone who does not have health insurance for more than 2 months would see a 30% premium surcharge on any plan they purchase.

As noted above, while the Senate version originally had no penalties for people who do not maintain coverage, a revision may address this issue.

It is not a “Done Deal”

While the Senate is set to vote on the Bill on Wednesday, there are still Senators who are on the fence about whether or not to vote for it.

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