“The American Health Care Act” Explained


A Simple Version of Everything You Need To Know About the ObamaCare Repeal and Replace Plan

We explain “the American Health Care Act” (The New ObamaCare Replacement Plan) in simple terms. You can see our full review here or see a simple pros and cons list here (the list below offers some opinion, like the opinion that taking away Medicaid from tens of millions of Americans is “not good”, so if you want less opinion added in, see our full review; otherwise this review is accurately representing the plan).

UPDATE: This plan didn’t pass the House the first time, but then it did the second time, and it is now at the Senate.Things are moving very quickly, so see a simple summary of the AHCA as it stood when it got to the Senate. This page just acts as a summary of the major provisions (which are subject to change). See: A Full Review of the House Republican ObamaCare Plan (aka Trumpcare, Ryancare, AHCA, and Obamacare 2.0) “the American Health Care Act” for more details.

NOTE: You should see a basic review of ObamaCarea basic review of the Better Way (Ryancare) plana basic review of TrumpCare (as presented on DonaldJTrump.com), and “the Last Week Tonight with John Oliver (HBO) where he discusses the Repeal and Replace plan.” It is a smart and simple summary despite its pro-ACA bias, semi-racy content, and comedic tone. The basics are easy to understand, the details are more complex. The better you understand the basics, the better you can understand how the new plan is and isn’t different from ObamaCare.

TIP: Don’t confuse this new bill with “the World’s Greatest Health Care Plan” by Pete Sessions. That is another ObamaCare proposal. This one, the RyanCare that Trump supports, is called “The American Health Care Act.”

American Health Care Act Facts: Facts on the Bill that Could Become TrumpCare

Here are the basics of “the American Health Care Act” (the latest official iteration of the House Better Way Plan):

NOTE: Some information below is from the leaked draft, we reviewed the official bill here. The following is still generally correct since the changes were minor. Once things are more certain we will create one final page and make sure all are clearly pointing to that one. For now, this is the gist of what the new healthcare act does.

  • Most of this starts in 2018 and 2020 (after Congress is elected once or twice and Trump gets another shot). They do a “slow rug pull” (like when a magician pulls the tablecloth off the table so fast that things don’t fall off; except with a slow pull things fall everywhere, slowly). For example, Medicaid is defunded in 2020 (date subject to change), so people don’t lose coverage until after the GOP is reelected (that is a fact and should be noted). That said, this is notably better than “just repealing Medicaid expansion.” UPDATE: This date has changed a few times since we wrote this.
  • The plan takes away the fees for the mandates, but not the mandates themselves. It also takes away most taxes on industries. You can imagine what happens when the federal government is starved of revenue; the deficit isn’t going down without other serious cuts, to say the least.
  • The plan includes a continuous coverage exclusion which allows insurers to charge you 30% more if you have a gap in coverage of more than 63 days. After you pay in for 12 months, it goes back to normal. This is arguably a fair trade for the mandate, but it will also prevent low-income Americans from accessing coverage in many cases. I’m not sure how this fills the market with young people, but there are many worse ideas out there. Supporters of the law should give due credit where credit is due, the GOP keeping preexisting conditions protections is a big deal.
  • The plan replaces income-based tax credits and out-of-pocket cost assistance with age-based cost assistance. This works well for some groups and fixes some sticking points, but older people (under 65) with lower incomes and low-income young people with higher medical costs are going to lose a ton of assistance. Those with chronic conditions who depend on out-of-pocket cost sharing would be in trouble. As a plus, those stuck with high costs due to income just over the 400% poverty level under ObamaCare will feel some relief here (that is a very good thing).
  • The plan repeals Medicaid expansion (pulling the rug out slowly) and block-grants traditional Medicaid. This likely results in less funding for states. It is good that states get to keep their programs, but the lack of funding could undo many of the positive changes.
  • The plan expands HSAs. HSAs can be very beneficial, but people hate them. The idea is to encourage you to put money into a savings account with tax advantages. You can then use the funds for a broad range of healthcare costs. This is a good idea for those who have the money to set aside. We have them now, but people from all walks of like tend to yell at me a lot when I suggest using them. The new limits essentially replace cost sharing subsidies, but I suspect that people with no extra cash are going to be furious. That being said, HSA changes suggested by this leaked draft will help a lot of people without significant tax revenue loss. Those changes include: making the HSA contribution limit equal to the HDHPs maximum out-of-pocket limit; allowing people to purchase OTCs; reducing the tax penalty for use the funds for non-approved medical spending; allowing older couples to make catch-up contributions together; and a 60 day window after purchasing an HDHP for an HSA to be establish with tax benefits backdated from the start of coverage. It’s a bit surprising that GOP plan doesn’t drop the requirement to have an HDHP altogether and allow every one an opportunity to get the tax benefits of these savings accounts.
  • It would increase the taxes paid by middle-class workers on their wages by making the value of employer insurance taxable income. At the same time, it would cut taxes on employer benefit packages valued over $500,000, the tax on incomes over $200,000-$250,000, the tax on insurers’ profits, and the tax on brand-name pharmaceutical companies.
  • And way more including strange things like defunding parts of the brand new 21st Century Cures Act that the GOP just passed. They defund sections of a highly touted ‘bipartisan’ Act that just passed. Also, abortion coverage and such is stripped away in very specific ways. That is, of course, a tricky issue. It could have a dramatic effect the way insurers in every sector offering this coverage (or not).
  • The bill also partly defunds Planned Parenthood by making it so they can’t take Medicaid payments using complex wording. They don’t name PP directly, add a catch that says “For a state to receive funding for Medicaid (or a waiver) for payments to any non-profits (or anyone associated with them) who provide abortions (except under the Hyde Amendment) whose funding from Medicaid as a nationwide health care network exceeded $350,000,000 in the fiscal year 2014”. No matter what your politics, it seems unfair to hide a Planned Parenthood repeal in a repair plan (meaning, thoughts on this provision aside, it should be its own conversation, not hidden in an ObamaCare repair bill).

Thus, the plan helps high earners and businesses the most, is a wash for the middle class depending on individual out-of-pocket medical costs and stands to leave tens of millions of uninsured/underinsured with access to an underfunded sick pool or nothing at all.

That is the gist, some of the far-right and Libertarians want way less, Democrats and progressives will want more. That means one will have to fight to get even this much. Things are very much up in the air.

Here is an example of how tax credits change, you’ll need to see the full review below for the details. We will be creating another simpler summary soon, for now, we hope this helps.

The tax credit would be paid for each month a person had coverage from the first day. A taxpayer is eligible for is 1/12 of these annual amounts for each covered individual based on their age:

  • Under 30: $2,000 ($166.67/month)
  • 30-39 years old: $2,500 ($208.33/month)
  • 40-49 years old: $3,000 ($250/month)
  • 50-59 years old: $3,500 ($291.67/month)
  • 60 and up: $4,000 ($333.33/month)

Limitations on the tax credit:

  • $14,000 ($1,166.67) Maximum tax credit for a single tax return (dependents included)
  • For large families, it is based on the 5 oldest members of the tax family

3/4/2017 UPDATE: A newer draft of the House bill to repeal and replace the ACA was reportedly leaked 3/3/2017. While this new leaked draft itself has not yet been made public, it is being reported that it is essentially the same, but will now exclude high-income earners from being eligible for the refundable tax credit which replaces the Premium Tax Credit. It also seems essential health benefits will stick around. We are going through the latest bill and will have all the updates posted shortly.

NOTE: Those assistance amounts are generous when you consider that the GOP ran on repeal. It is tempting to be upset, but the reality is that Ryan and his team have become odd allies of ACA supporters compared to the more extreme right. They appear to be making some small steps in the right direction. There are big, big scary problems and attacks on poor people and women in here, but perhaps, with continued pressure from informed constituents, positive changes are possible. This is, in many cases, more than our team was expecting. So try to keep that in mind.

Author: Thomas DeMichele

Thomas DeMichele is the head writer and founder of ObamaCareFacts.com, FactsOnMedicare.com, and other websites. He has been in the health insurance and healthcare information field since 2012. ObamaCareFacts.com is a...

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Michael Griffith

Your going to tax my employer provided healthcare, that I pay a portion of? I cant win Democrats raised my premium cost now Republicans are going to tax my insurance that I have cause I have a job. Where are legistlators that really care about people?

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I am not happy that they have a provision to increase payroll taxes for middle class workers while at the same time eliminates most healthcare tax paid by industries.

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My God, oh no, oh hell no. Shifting this plan to the IRS will be a certain disaster, there will be chaos. People will be thrown into a state of confusion and will not know how to proceed, the law its was poorly written it is so vague one cannot discern a clear and plausible understanding of it. What a mess this is going to be. He’s throwing health care back to the states but then he declares jurisdiction to the Federal Courts, if we are talking about Insurance Law, that’s State, not Federal, he’s tearing down the entire Court system Structure. I don’t know, this is not good, the language is way to vague, certain illnesses, Medal of Honor?????? How rational is that? I don’t like it. I think it will be a disaster, why because all these people who are expected to develop it, can’t the existing agencies are incompetent the secretaries are the ones who are calling the shots, and its everywhere. They’ll be more corruption than the days of Tammany!!!! I don’t like it. Its reckless, its poorly written and you’d have to be a mathematician to figure it out????? Not good. What a mess. We have no one but ourselves to blame, we keep putting the wrong people into power and then we turn our heads and don’t want to take responsibility for what they do as a result of our own negligence!!!

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It boggles the mind, that in this day and age, these “so called leaders” of our country, cannot come together and form a well thought out plan that is doable for all. I am sick and tired of the banter between Democrat and Republican. This is the cancer of our country, void of a perspective as Americans to place country over party.

The issue that bothers me about the ACA as I read through the Obamacare facts, the obvious goal getting everyone insured and stating how many more millions have coverage, but what kind and quality of coverage? Just because one now has healthcare, is it really effective? Does it provide the necessary needs of the patient? Is it just a matter of numbers to make it appear it’s truly a benefit? And let’s not forget when they rave about how many millions have signed up for coverage, many are motivated because it’s the law!

When I was a young man in my twenties, healthcare never crossed my mind, and I would have opposed me being forced to have insurance when I felt I couldn’t afford the premiums or just preferred to spend my money on something else. In my view, the Government forcing me to engage in something I resist, for my own good, is wrong. And where does it say, everyone MUST have healthcare every year of their life? As you might surmise, I loathe insurance. The average person is poor due to the multiple items we pay for insurance; but you better never use it, and when you do, more than likely there will be a penalty.

What I don’t like about the plan are the subsidies. Everyone complained about those showing up at the Urgent Care Centers and not paying their bill. Well what’s the difference if they have healthcare and someone else is paying for it? It still falls on the taxpayer who covers his own insurance, and has to bail out others.

If this Republican effort to revise Obamacare is done primarily for political reasons, rather than getting it right, then I will have to say, and I’ve been wavering for sometime about our political system, this will put me over the edge.

The fact that the Democrats are hoping and praying for Republicans to fail at improving the healthcare situation, sitting on the sidelines, not offering to participate and voice their concerns, is a travesty. We should dock their pay while they are observers. They are negligent in their duty to work for the American people, and the voters should make them pay for their incompetence.

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Excellent reply. One point, however, I would like to add is the flaw in their premise. They mandated coverage for everyone, assuming that young people would be paying for something they would not use that would then even out costs for older people who need more. I won’t even go into the ethical issues of forcing extra costs on young people who generally do not make much money or are still in school. The premise itself was flawed. You mentioned that at 20 you were not thinking about health coverage. Neither was I, but in today’s society that is not the case. Millions of young people today take medications. My 19 yr old daughter takes 6, and she is not disabled. She graduated with a 4.0 in all Honors and Dual Enrollment classes and is currently at a university with all of her fees paid by scholarships. She has friends that have seizure disorders, diabetes, and ADHD. Then, there was the fact that many young people qualified to remain on their parents insurance, or for extended Medicaid as well as those who had not opted for treatment when it was coming out of their pocket, but now that they had insurance decided they might as well use it. The final piece they failed to consider was people who chose to ignore the mandate. For some, it was simply cheaper to pay the tax penalty. When all of this was added together, they created a plan with no foundation to pay for it, one that drove up costs for both the medical industry and the individual.

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Whoever wrote this article, THEIR tone was biased. Definitely against Republican favoring Democrat, its too obvious. Lets be fair and write an article without any snide remarks.
Is all this info from a reputable source?
It states all rates with healthcare will go up, that is a ridiculous statement since Obamacare was slated to go up big time this coming year anyway.
I know people on it who have HUGE deductibles, doctors don’t want to take it and insurance companies are dropping like flies in the states that provide it.
All this article is stating all negative with the republicans when it refuses to admit their are MAJOR flaws now with it. AND NO I should NOT have to pay for somebodys abortion because they did not take responsibility for themselves, abortion is not healthcare or a medical condition. They should pay for themselves we should not be forced to pay that and also against MANY peoples religious beliefs as well. Author should just state facts leave their angry attitude out of it.

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This looks like a typical Republican bill that will move money to the rich and large corporations and take money and benefits away from the older and poor members of our society. Pathetic! The ACA only needs minor changes. I had no changes to my deductibles or copays in the 3 years of my coverage. I received a refund twice from the insurance co. due to the part of the ACA that requires insurance companies to use atleast 80% of the premiums for health care. Fix the problem with insurance companies gouging the public. Perhaps the one payer system is the best.

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I wish the Government never got involved in my Health Care I have coverage that is worthless just like the Doctors General Practitioners in my plan they don’t send you to a specialist they do everything and are clueless when it comes to women s issues I have been paying out of pocket to see a Doctor that can treat me and if I don’t get a check up every year the Doc will drop me last time I went to him his nurse wanted my weigh and I refused she said I had to because my insurance wanted it I told her to have them give me a call and hell no would I give my family health history it can be shared with anyone its creepy .

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JACQUELINE MCCARTHY

I am wondering how middle class Americans who are fortunate enough to receive health benefits under their employer, with or without a co-pay will really be affected by this Trump Tweaked version of Obama Care.

IF ONES INCOME IS TAXED BASED ON THEIR COMBINED INCOME AND FULL COST OF BENEFITS; Would one get to use the maximum TAX CREDIT FOR THEIR AGE? Or would one only be able to deduct their actual co-pay?

The cost of a family plan would add approximately $20,600 to my taxable income. Of this I pay approximately $1,000.
Interestingly, I went to https://smartasset.com/taxes/income-taxes#msapwrCciz,
and put in our household income to see the difference in federal taxation. (I urge everyone who has an employer provided plan to do this). I would be paying $5,000 more in in federal income tax, and my income after taxes increases $13,420, except that my take-home pay doesn’t increase at all…. it is simply a paper shuffle hiding the fact that I am going to be paying $5000 more for my health insurance to the Federal Government in an indirect way. Does my employer get the $5,000 back or does the federal Government get it?

Also in need of consideration, is that with the cost of health insurance being added to a household’s income, a college age student could lose a PELL grant they would otherwise be entitled to even when the families take-home pay has not changed at all. What other Federal or possibly State subsidies could be affected?

Am I interpreting this change correctly?

Many Americans also do not trust the current administration enough to wait and see what “Phase 2 and 3” propose. We can’t afford to wait and see.

**Our elected officials need to think through every aspect of this proposed change in how “household income” is reported, regardless of party affiliation. As usual it looks like the working class and the poor have the most to lose.

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Beverly J. Druskis

I read it-did not fully understand it-and feel it was written biased by the Democratic Party-it seems like the author who wrote this -is leaning to the left-I’m eighty-seven -I’m not on medicaid-I have friends on Medicaid-do they need to worry in 2020?
I also have very wealthy friends-I’m not one-I live on less then $20,000 a year and pay my c-pays to the doctor-I think if President Trump ddoesn’t want to hurt his ratings, he better get on the ball and speak to the american people just what it will and won’t do for the American people!

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MY NAME IS CRAIG NELSON, I AM 63 YEARS OLD. PRESENTLY WORKING FULL TIME WINDING ELECTRIC MOTORS IN WISCONSIN. OWNED A ELECTRIC REWIND SHOP 20 YEARS IN MN., OWN A HOUSE IN NORTH WI., PAID INTO SS AND TAXES AND INSURANCE FROM EMPL,OYERS SINCE 1970.

EMPLOYEE’S PAYING HEALTH INS., A FEW MONTHS OR SEVERAL MONTHS. MAYBE SEVERAL YAERS. WHEN CHANGING THIER JOB’S, WHY IS NOT THE INSUARNCE COMPANIES REQUIRED BY LAW TO COVER ANYONE THAT HAS PAID INTO THE INSURANCE COMPANIES POLICIES!!??

I CAN WORK FOR 12 MONTHS OR EVEN 12 YEARS AND PAY INTO DENTAL AND OR HOSPITAL DOCTOR INS. MAYBE NOT NEEDING IT MUCH, THAN LOOSING THE POLICY BECAUSE I QUIT THE JOB OR GET FIRED OR LAID OFF. PAYYNG FOR YEARS THE CEO TO GET HIS MILLIONS A YAERS SALARYY?!!

THIS IS NOT RIGHT! INSTED OF MEDICARE AND MEDICADE FOR ELDERLY PEOPLE THAN CANNOT AFFORD A LOT FROM THE SS, THESE INSURANCE COMPANIES SHOULD BE PAYING THE FREE CARE OF HOSPITAL AND DOCTOR VISITS—-ESPECAILLY TO THOSE THAT HAVE FOR ALL THEIR WORKING LIFE HAVE PAID THE KITTY OF HEALTH INS AND SS AND FED TAX AND STAE TAX!! AND YOU, THE SENATE OF THE USA CAN GIVE THE MONEY FROM SS AWAY TO PEOPLE THAT WERE NEVER FEEDING INTO THE SS SYTEM AND NOT EVEN CITISENS OF THE USA!!??? WHERE IS YOUR CONSCIENCE?!

CHANGING AFFORDABLE CARE ACT , SHOULD REVOLUTIOINARY CHANGE THE TAX MONEY FLOW PUT INTO THE USA, NOT TO PAY FOR KILLING HUMANS AROUND THE WORLD FOR THE ELLITE RICH! BUT TO CARE FOR THOSE THAT ALL THEIR LIFE PAID YOUR FUNDS YOU ILLEAGALY USED.

SOCAIL SECURITY BENIFITS SHOULD BE MORE THAN ENOUGH TO LIVE MONTHLY ON, AND IT IS INSTEAD BE STOLLEN FROM US AND NOBODY IS BREAKING THE LAW?

I WAS BORN WITH EPILEPSY, PETTI MALLS. 20 PILLS A DAY I TOOK, WORKED BEST I COULD. 43 YAERS OLD, WAS NOT ON DISABILITY. HAD TO HAVE BRAIN SURGEORY. THE SURGEON REMOVED THE SCAR THAT CAUSED SEISURES!! THANK YOU JESUS!
THANKYOU MN GOVERNMENT THE SURGEORY WAS PAID FOR. I WAS ON DISABILITY FOR 1 YEAR, NOT ABLE TO GO BACK TO WORK 3 YEARS, IT TOOK 18 MONTHS BEFOR DISABILITY WAS GIVEN. I DID NOT STAY ON DISABILTY, WANTING TO PAY FOR MY RETIREMENT AND GET A BETTER AMOUNT THRU SS. SINCE 1996 THE SUGEORY AND 3 YEARS WITHOUT BEING ABLE TO WORK. I HAVE BEEN BACK WORKING AND PAYING INSURANCE AND TAXES AND SOCAIL SECURITY.

TURN THE INSURACE COVERAGE AROUND AND SS AROUND TO PAY BACK WHO HAVE PAID INTO IT. REQUIRE THE INSURANCE COMPANIES TO COVER EVRYONE THAT HAS PAID THE FIDLER. OR ARE YOU JUST GOING TO PASS A BILL AND SAY IT IS BETTER, BUT NOT GOOD ENOUGH. REVOLUTIONARY CHANGE SHOULD BE NOW! BEFORE I CAN NOT RETIRE AND MY GRANDCHILDREN AND YOUR GRANDCHILDREN WILL HAVE NOTHING TO MAKE THEIR LIFE BETTER!! IF YOU CANNOT TAKE CARE OF THIS YOU SHOULD BE FIRE AND PUT INTO PRISION FOR MISHANDLEING THE MONEY AND LAWS.
AND CONSTITUTION THAT WHERE GIVEN TO YOU TO USE RIGHTLY!! AND IMPRISIONED FOR NOT LISTENING TO YOUR CONSCIENCE!!

SINCERLY, WORKING WITH NO REAL PLAN TO QUIT AND STILL PAYING IN TO THE SS, STAE TAXES AND FEDERAL TAXES. CRAIG NELSON

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Thank you Craig Nelson for sharing your story. You’re work ethic and loyalty to doing the right and responsible thing is much admired! Perhaps our legislators need to focus on doing the “right things for the right reasons”!

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Zerohedge recently published a good article on healthcare.

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I agree!!!–Furthermore-every paycheck you get in your working life YOU ARE PAYING FOR HEALTH CARE FOR SOMEONE!!–EVERYONE SHOULD HAVE DECENT HEALTHCARE IN A CIVILIZED COUNTRY!!! WHY IN THE HELL DOES EVERY OTHER CIVILIZED NATION ON THIS PLANET HAVE IT -BUT NOT THIS CAPITALISTIC PIG COUNTRY???–BECAUSE THE WEALTHY ELITE ONE PERCENT WHO HAVE 99 PERCENT OF THE WEALTH THAT WORKING SLAVES LIKE ME PRODUCE DON’T WANT IT–THEY JUST WANT TO USE YOU FOR THEIR BENEFIT –UNTIL YOU GET TO OLD TO WORK AND THEN THROW YOU ON THE STREET—WAKE UP AMERICA–BEFORE IT IS TOO LATE-IT MAY BE ALREADY–

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Simplistic summary that while informative does not really set forth how harmful this replacement will be for poor, seniors and middle class. Specifically any changes to medicare will eventually cost middle class in long run as they will need to replace medicare with market value health care when they turn 65. Costs will be exorbitant at that age. Premiums will be through the roof as will medical costs. A bill that does not control costs is fruitless and lies to the public about individual and public costs of the replacement.

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I think that it is time for Democrats and Republicans to work together for the good of the American citizens. The Affordable Care Act may help the poorer Americans but it is crushing the rest of us who have to shoulder the cost. My premiums and high deductibles are unsustainable. My choice of insurance plans has been reduced to one and my choice of doctors has been greatly limited. When I recently had surgery, I had to pay before the surgery because the doctor said patients with high deductible health plans were not paying for his services.

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