The Difference Between ObamaCare (The ACA), the Senate’s TrumpCare (BCRA), the House’s TrumpCare (the AHCA) Explained

We explain the difference between ObamaCare and the House and Senate versions of TrumpCare (i.e. the difference between the ACA, AHCA, and BRCA).

The following table shows the main difference between ObamaCare, the Senate’s Better Care Reconciliation Act of 2017,  and the Houses American HealthCare Act (the initial bill which passed the house that many are calling TrumpCare):

The Difference  The Basics of TrumpCare; The Senate Version (The Better Care Reconciliation Act of 2017 or BCRA) The Basics of TrumpCare; the House Version (The American HealthCare Act or AHCA) The Basics of ObamaCare; the Current Law (the Affordable Care Act or ACA)
Employer Mandate Large Businesses don’t have to provide insurance to full-time workers or pay a fee (retroactive starting in 2016). Large Businesses don’t have to provide insurance to full-time workers or pay a fee. Large Businesses have to provide insurance to full-time workers.
Individual Mandate There is no individual mandate (the requirement to get coverage or pay a fee). Instead, there is a 6 month waiting period to reenter the market if you have a gap in coverage for more than 63 days in the previous year (meaning if you apply for coverage during open enrollment or during a special enrollment you have to wait 6 months from the date of application to enroll in coverage). There is no individual mandate (the requirement to get coverage or pay a fee). Instead, there is a 30% charge for 12 months if you have a gap in coverage for more than 63 days and reenter the market. There is a fee if you don’t maintain coverage or an exemption each month (for those who can afford it).
Pre-Existing Conditions Preexisting Conditions are covered, but state-based waivers can be used to exclude certain conditions from lifetime and annual limits (but people of the same age on the same plan can’t pay higher premiums or cost sharing). Preexisting Conditions are covered, but state-based waivers can be used to exclude certain conditions from lifetime and annual limits and can be used to charge sick people more (although the state must establish a high-risk pool). No one with pre-existing conditions can be denied coverage or charged higher insurance rates.
Essential Health Benefits States can waive essential health benefits and therefore reinstate annual and lifetime limits. The state-based waivers could result in women and sick people, who rely on essential health benefits and their annual and lifetime limits, paying more (or even being excluded from the market due to cost). States can waive essential health benefits and therefore reinstate annual and lifetime limits. The state-based waivers could result in women and sick people, who rely on essential health benefits and their annual and lifetime limits, paying more (or even being excluded from the market due to cost). Essential health benefits are covered on all plans with no annual or lifetime limits.
Cost Assistance Tax credits are based on income and age for those making up to 350% of the Poverty Level (the credits start at 0% and stop at 350% creating a cliff; but expanding credits to 0% – 100% to offset Medicaid cuts). Out-of-pocket assistance is extended on a per-month basis until 2019. Tax credits are based on age for those making up to 600% of the Poverty Level (the credit then phases out slow); out-of-pocket assistance is cut. Those making between 100% – 400% of the poverty have access to premium tax credits based on income; out-of-pocket assistance is offered for 100%-250% FPL.
Medicaid funding Obamacare’s Medicaid expansion is phased out over four years, funding is cut, and extra dollars are given to states who spend less on Medicaid (and taken from states who spend more). 90% of the current federal funding would be provided in 2020, and it would decrease by 5% each year until 2023, after which it would be eliminated. People would not be allowed to join the expansion from 2020 onwards. Also, there is a per capita cap for federal Medicaid spending. After 2025 growth in spending would shift from the consumer price index for medical care to the CPI for all goods, a lower level of growth. That means Medicaid expansion is frozen, states who expand on their own are punished, states will get less funding for Medicaid in general, and federal funding will continue to decline after 2025. Medicaid expansion funding is frozen; block-grants might be added to a later bill. Medicaid is expanded to all adults in all states that expand and the Federal Government pays 90% of the costs.
Taxes TrumpCare cuts most taxes on industry. This includes the 3.8% tax on high earners. TrumpCare cuts most taxes on industry. This includes the 3.8% tax on high earners. ObamaCare taxes those who profit the most off of healthcare.
Ratios Older Americans can be charged 5x more than young people under TrumpCare. Premium costs for the same plan for the same age customer cannot differ (community ratings). Older Americans can be charged 5x more than young people under TrumpCare. Premium costs for the same plan for the same age customer can differ (no community ratings). Under ObamaCare you can’t be charged more for having a preexisting condition. Older Americans can be charged 3x more than young people. Premium costs for the same plan for the same age customer cannot differ (community ratings).
High-Risk Pools TrumpCare allows for high-risk pools to create a state-funded (tax payer funded) reinsurance program (via state level waivers). TrumpCare allows for high-risk pools to create a state-funded (tax payer funded) reinsurance program (via state level waivers). The Affordable Care Act expanded coverage and got rid of high-risk pools.
Cost and Coverage The plan according to the Congressional Budget Officesaving $321 billion over the decade. However, it did this by leaving 49 million without coverage by 2026 (it increases the uninsured by 22 million by 2026 for a total of 49 million uninsured). The cost and uninsured rate are subject to change based on changes to the bill. This bill notably saves more and covers more than the House bill. The plan (after amendments) had a price tag that came in under the ACA according to the Congressional Budget Officesaving $119 billion over the decade (according to their first report). However, it did this by leaving 52 million without coverage by 2026 (it increases the uninsured by 23 million by 2026 for a total of 51 million uninsured). The cost and uninsured rate are subject to change based on changes to the bill. The Affordable Care Act, therefore, costs $321 billion more and insures 22 million more people by 2026 than the Senate Bill.
Bottomline The Senate’s TrumpCare might bring premium costs down for some, but less assistance and less on healthcare means hospitals and the sick, poor, and elderly will see new hurdles while the most wealthy (business, large employers, high earners) will see tax breaks. The House’s TrumpCare might bring premium costs down for some, but less assistance and less on healthcare means hospitals and the sick, poor, and elderly will see new hurdles while the most wealthy (business, large employers, high earners) will see tax breaks. The Affordable Care Act reduced the uninsured and bankruptcy and helped keep hospitals full, but people were struggling with costs. For those with assistance, however, the ACA meant tens of millions had access to affordable coverage for the first time. Currently, uninsured rates are at an all-time low.

 

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