What’s in the Senate’s Obamacare repeal bill

The Senate’s sweeping Obamacare repeal plan released Thursday would strike the biggest parts of the health care law, end Medicaid as an open-ended entitlement and give states the ability to waive the health law’s insurance requirements. Here are key features:

Pre-existing conditions: The plan would keep the Affordable Care Act requirement that insurers accept everyone and charge the same rates, with few exceptions. But it would allow states to waive other insurance requirements, including rules for what benefits insurers must cover, that could weaken protections.

Insurance subsidies: Obamacare’s premium subsidies, which are available to people between the poverty level and four times that threshold, would be continued for two years. Eligibility would then be scaled back slightly to 350 percent of the federal poverty level and extended to more low-income people who don’t qualify for Medicaid. Similar to Obamacare, the subsidies would be pegged to income. But the benchmark plan for determining subsidies would be less generous than Obamacare’s.

The bill would also extend for two years Obamacare’s cost-sharing subsidies, which help insurers pay medical bills for low-income customers. President Donald Trump has threatened to cut off those payments, which health plans said could destabilize the individual insurance marketplaces.

Individual and employer mandates: The health law’s mandate that most people buy insurance or pay a penalty would be eliminated. So would the requirement for mid-sized and large companies to provide coverage to workers.

Older customers could be charged more: Insurers would be allowed to charge older customers five times more than younger ones for the same health plan. Under Obamacare, that ratio is three-to-one.

Medicaid expansion: Boosted federal payments to states that expanded their programs to low-income adults would continue for three years. Starting in 2021, enhanced federal payments would then be rolled back over three years to traditional Medicaid funding rates. Thirty-one states and Washington, D.C., have expanded their Medicaid programs under Obamacare.

Traditional Medicaid: The program covering low-income kids, pregnant women, the elderly and people with disabilities would no longer be an open-ended entitlement. Starting in 2020, states could choose between receiving a block grant from the federal government or a set payment based on the number and type of enrollees. The payments would slightly increase each year, but starting in 2025, the growth rate would be lower than what the House bill prescribes. Certain populations would be carved out from the payment caps.

Taxes: The bill would eventually repeal most of Obamacare’s taxes, including the surtax on high earners investment income and a Medicare Hospital Insurance surtax on the rich. It would also end some industry taxes, such as those on medical devices and health insurers.

Abortion: Subsidies could no longer be used to purchase health plans that cover abortion. Medicaid funding for Planned Parenthood would be cut off for one year.

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