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How is the House Republicans’ American Health Care Act different from Obamacare?

House Ways and Means Committee Chairman Rep. Kevin

House Ways and Means Committee Chairman Rep. Kevin Brady, R-Texas, left, and House Energy and Commerce Committee Chairman Rep. Greg Walden, R-Ore., meet with reporters on Capitol Hill in Washington, Tuesday, March 7, 2017, as House Republicans introduce their plan to repeal and replace the Affordable Care Act. Credit: AP

The new health care bill the House Republicans released on Monday March 6, has similarities to President Barack Obama's Affordable Care Act, like tax credits, protections for people with health problems and the ability for parents to keep young adults on their insurance.

But in some cases those components would work differently under the GOP framework than is currently the case with the ACA, or Obamacare.

Key details about the Republican plan are still unknown, including cost and coverage. Here's a comparison between Obama's ACA, which is current law, and the GOP's bill, named the American Health Care Act:

Individual mandate

Current law: The Affordable Care act requires people who can afford health care to purchase it or face tax penalties.

GOP bill: The plan would eliminate the requirement for individuals to carry health insurance. However, consumers who have not maintained continuous insurance coverage would face a 30 percent premium penalty for a year. 


Current law: States that accept expanded Medicaid receive a generous federal match, gradually phasing down to 90 percent. The expansion covers people with incomes as high as 138 percent of the federal poverty line, or about $16,640 for an individual. Most new beneficiaries are low-income adults with no children living at home.

More broadly, Medicaid is now the country's largest health insurance program, covering more than 70 million people under a federal-state collaboration. It remains an open-ended entitlement, allowing states to draw down federal money for a portion of health costs incurred by low-income people, from children to nursing home residents.

GOP bill: Ends the higher federal match for Medicaid expansion beneficiaries, starting in 2020. States can still continue to receive some enhanced federal payments, but only for expansion enrollees who were already covered before that. States will get a lower match for new enrollees.

But more significantly, the bill would overhaul the framework of Medicaid, ending its open-ended federal financing. Starting with the 2020 fiscal year, each state would receive a limited, per-beneficiary amount based on enrollment and costs. States would gain flexibility to cap enrollment and change benefits. Federal payments would be increased according to a measure of medical inflation. Impacts are unclear.

Private coverage for individuals

Current law: Provides income-based tax credits for consumers buying government-regulated plans through and state insurance markets. The most generous assistance goes to people with low to modest incomes. Many solidly middle-class households get no help despite sharp increases in premiums.

GOP bill: Provides tax credits primarily based on age, gradually phasing down for individuals making more than $75,000, or married couples earning more than $150,000. Credits can be used to buy any state-licensed health plan. More middle-class consumers will benefit, but there's concern lower-income people would be disadvantaged.


Current law: Provides cost-sharing subsidies for low-to-moderate income people who buy a standard silver plan in the government markets.

GOP bill: Eliminates ACA's cost-sharing subsidies, but allows people to make much higher contributions to tax-sheltered health savings accounts, to cover deductibles and copayments. Sets up a fund that states can use for a variety of purposes, including cost-sharing assistance.

Pre-existing conditions

Current law: Forbids insurers from turning people down on account of medical problems, or charging them more.

GOP bill: Provides protection for people with health problems. States can use federal funds to set up high-risk pools as insurers of last result.

Generational Balance

Current law: Insurers can charge their oldest customers no more than 3 times what they charge young adults. That benefits older adults prone to illness but has made coverage costly for young people.

GOP bill: Insurers could charge older customers as much as 5 times what they charge young adults. Advocates for older people complain that's unfair.

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