6 things you should know about Trumpcare

House Republicans released the long-awaited bill on Monday.

A girl stands holding a sign alongside supporters of the Affordable Care Act CREDIT: AP Photo/Brennan Linsley
A girl stands holding a sign alongside supporters of the Affordable Care Act CREDIT: AP Photo/Brennan Linsley

House Republicans released on Monday a plan to undo Obamacare that will likely leave millions more Americans uninsured.

After significant internal division about the path forward on Obamacare, lawmakers unveiled two bills that, taken together, would repeal and replace President Obama’s signature health care reform law. House committees are expected to hold votes on the bills as early as this week.

Here’s what you need to know about the legislation, and what it says about the House GOP’s plan for the future of health insurance in America:

It includes massive cuts to Medicaid, the program that provides coverage for millions of low-income Americans.

The proposed replacement bill includes big cuts to Medicaid, the government program that provides coverage for low-income Americans.

It would phase out the Medicaid expansion under Obamacare, which extended coverage to more than 11 million low-income people, beginning in 2020. It would also restructure the way the entire program is funded — offering states a lump sum to administer Medicaid coverage rather than providing however much funding states need to cover the pool of Medicaid eligible residents — putting the future of Medicaid in jeopardy.

It defunds Planned Parenthood and eliminates abortion coverage.

The GOP’s replacement proposal includes two major provisions aimed at eroding access to reproductive health care.

One would bar Planned Parenthood from using federal funding toward its family planning services, which would prevent the women’s health organization from providing birth control and mammograms to 2.5 million current patients who are covered through Medicaid. The other would prevent Americans from using their tax credits to help pay for plans that include coverage for elective abortion services — essentially, singling out abortion care as a service that won’t be covered like other medical procedures and forcing low-income people to bear the full out-of-pocket cost of ending a pregnancy.

It includes a big tax break for insurance companies that pay their CEOs more than $500,000 per year.

One provision in the House GOP’s proposed Obamacare replacement plan would essentially incentivize major corporations to overpay their top executives — offering a tax break to insurers that pay CEOs more than half a million dollars per year.

A significant portion of the bill is devoted to ensuring lottery winners don’t have access to Medicaid.

One of the most bizarre inclusions in the legislation is a provision that would prevent lottery winners from being able to remain covered by the Medicaid program. The 66-page document spends seven of those pages detailing this policy change.

It could trigger a “death spiral” in the individual insurance market.

The proposed replacement plan confronts the same issue that Republican lawmakers in Congress have been grappling with for quite some time: How do you preserve the most popular parts of Obamacare, eliminate the least popular popular parts of Obamacare, and keep the insurance industry functioning smoothly?

The GOP’s proposal would maintain Obamacare’s requirement that insurers need to cover people with preexisting conditions. But it would also scrap the law’s main avenue of balancing out those sick people with younger, healthier enrollees — the individual mandate that requires all Americans to sign up for health insurance or pay the IRS a fee.

Instead, the GOP measure introduces a provision that requires “continuous coverage.” Essentially, anyone who goes without insurance for two or more months and then tries to sign up for coverage again will be required to pay 30 percent more on their premiums for the next year.

There are two issues with this change. First of all, instead of paying the IRS, Americans will be required to give more of their money to insurance companies. And second of all, it’s unclear that this surcharge will be enough of a deterrent for young and healthy people who’d rather not have coverage. This could trigger what policy experts call a “death spiral,” threatening the collapse of the entire insurance industry as the individual market destabilizes.

It will result in a lot fewer people having health insurance.

House Republicans are still awaiting more detailed analysis of the new legislation from the Congressional Budget Office and nonpartisan health policy groups. But experts in the field agree there’s no way that it will maintain the same levels of coverage as Americans currently have under Obamacare, which extended health care to 20 million people. We’ll find out just how many fewer people will be covered after the CBO examines it.

Republican lawmakers involved in crafting the legislation acknowledge that fewer people will be able to access health insurance under their plan. Some legislators have construed this as a good thing, saying that more uninsured people signals a greater embrace of personal liberty and that some low-income people simply don’t want to take responsibility for their insurance.

House Republicans released Monday’s plan with the blessing of President Trump. But there’s still plenty of infighting in the Republican Party that ensures this legislation may have a rocky road ahead.

Some members of the Freedom Caucus oppose the way the legislation extends tax credits to help Americans purchase insurance, calling this provision a “new entitlement” — and aren’t likely to support the measure’s delayed repeal of multiple Obamacare taxes.

Meanwhile, some moderate Republicans in the Senate have expressed concerns about defunding Planned Parenthood and putting Medicaid expansion in jeopardy for their constituents. It’s unclear whether the latest version of the plan will sufficiently assuage those worries.