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Richard Wagner looks at the similarities and differences between the House and Senate bills to “repeal and replace” Obamacare, and how the Senate Healthcare Bill will affect Americans if passed.

As the American Health Care Act (AHCA) works its way through the Senate, many are concerned about how this will affect their current plans.  

Nearly two months ago, I compared the House version of the AHCA to the current Affordable Care Act (AKA “Obamacare”).  There are a few differences in the Senate version (Better Care Reconciliation Act).  But keep in mind that this article is based on the present version of the Senate Healthcare Bill, which could certainly change before it comes to a vote in the Senate.

How the Senate Healthcare bill differs from the House bill

  • Pre-existing conditions – Insurers could not decline coverage for pre-existing conditions, but allows states to ask permission to allow insurers in their state to implement a lifetime cap on certain services covered by insurers.  This would mean that if someone has a pre-existing condition in a state that has such permission, the insurer might be able to limit how much they spend on treatment in your lifetime.  
  • Medicaid work requirement – States would be allowed to require employment, or seeking of employment, to able-bodied Medicaid recipients.
  • Subsidies – the subsidies are more generous in the Senate version, being very similar to Obamacare.  Unlike in the House version, the Senate version would allow most people currently receiving subsidies to keep them, but those who are more than 350% of the poverty level would lose their subsidies (while Obamacare allows subsidies for those up to 400% of poverty).
  • Better Mental health funding – while neither version is particularly generous in funding mental health, the Senate version does create a $2 billion fund to provide block grants to the states to address mental health, as well as treatment for drug addiction.  So, the Senate version provides a little less funding for this than Obamacare, but with more flexibility to the states.

How they stay the same

Compared to “Obamacare”, the House and Senate versions have more similarities than differences.  While that’s stating the obvious, it’s important to highlight those similarities so that you can consider how this will compare to the current law of the land – Obamacare.

  • Individual Mandate gone – You would no longer be required to purchase health insurance or face a tax penalty.  
  • Those under 26 can stay on their parents’ plan – All three bills are in agreement here.  So unless something changes in the Senate bill or final version, which is very unlikely, this will stay the same.
  • Medicaid spending cap – many call this a “cut”, but it’s actually a cap on Medicaid spending.  Both bills have it, though the Senate version holds off on implementing these caps until 2021-2023, while the House version would have implemented them in 2020.  Medicaid spending increases would be limited.
  • The Actual Medicaid Cut – Under Obamacare, states were given the option to expand Medicaid coverage for those earning up to 133% of the poverty level.  This would be cut back to 100% by both the House and Senate versions.  

Richard Wagner is an Adjunct Professor of Political Science at Florida State College at Jacksonville. He conducts independent study on the American conservative movement and foreign policy. When he is...

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