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What's In The GOP Health Care Bill


Republicans are closer than ever to one of their dearest goals, repealing and replacing the Affordable Care Act. After weeks of secrecy, Senate Republicans this week unveiled their health care bill called the Better Care Reconciliation Act. And to help us sort through just what's in the new bill, we've brought in Noam Levey. He covers national health care policy for the LA Times. Noam, thanks for coming in.

NOAM LEVEY: Good to be with you.

BLOCK: How would you describe the broad contours of this bill?

LEVEY: Well, so the headline, obviously, is repeal of the Affordable Care Act - of Obamacare. But it's important to understand that that involves much more than just rolling back this sprawling law that President Obama signed seven years ago. It does eliminate large parts of that bill, but it actually goes further in a number of important regards, number one being it dramatically reshapes how Medicaid, this big, 50-year-old health care safety net program, is funded by the federal government going forward and fundamentally changes the kind of benefits that it offers to poor Americans.

BLOCK: Well, let's talk about that because Medicaid covers something like 1 in 5 Americans, 74 million people.

LEVEY: A lot of people.

BLOCK: What would change for Medicaid recipients under this bill?

LEVEY: So remember that the Affordable Care Act - one of its pillars was an expansion of Medicaid. Medicaid traditionally covered mainly poor children, pregnant women, the disabled and the elderly. But working-age Americans - working-age, poor Americans - were generally shut out of the program. And what the Affordable Care Act did was extend hundreds of billions of dollars of aid to states to allow them to expand the program.

What this bill and the House bill that passed about six weeks ago does is not only scale back and ultimately eliminate that additional federal aid. It also changes the funding structure that Medicaid has relied on. And that will ultimately cut hundreds of billions of additional dollars out of Medicaid in the years going forward.

BLOCK: And throughout the bill, one of the hallmarks is, as I understand it, shifting power from the federal government to the states. In other words, they can determine more of what they want to cover.

LEVEY: That's right. That's right. Recall that one of the real revolutionary breakthroughs of the Affordable Care Act was to establish, essentially, a national floor, a national standard for what health insurance ought to do. There were untold numbers of horror stories in the lead-in to 2010 about inadequate health insurance.

What this bill would do is essentially move back to what the world looked like before 2010. States would once again be able to say, well, we're not going to require our health insurers to cover maternity coverage or mental health coverage or substance abuse, which is obviously very important in the context of the opioid epidemic.

BLOCK: Let's talk about the people who are covered not through Medicaid but through the health care exchanges that were set up under the Affordable Care Act, which Republicans say have been a failure. How would this bill change that?

LEVEY: So the marketplaces did a number of things. As we talked about, they established this set of benefits. They also provided this system of subsidies to help people pay for their insurance premiums.

What the Senate bill would do is dramatically reduce the amount of federal assistance that's available to consumers who have to go onto these marketplaces and purchase coverage and, as we talked about just now, at the same time reducing the requirements on insurers selling plans on these marketplaces. The combination of these factors would likely do a few things. Number one, it would most likely allow insurers to offer plans with even higher deductibles than they currently do.

Now, the current law provides some additional assistance to lower-income consumers to help offset the cost of those deductibles. That assistance would be eliminated under the proposed legislation that the Senate unveiled. Additionally, with these new formulas, people would qualify for substantially less assistance to offset the cost of their premiums. So you may have a situation where you basically have skimpier health plans that are costing consumers more going forward.

BLOCK: We should explain, too, that part of this bill is a substantial tax cut on the wealthiest Americans.

LEVEY: That's right. So Obamacare included hundreds of billions of dollars of new taxes to offset the cost of this assistance. And we should remember that the assistance in Medicaid and in the exchanges was credited with lowering the number of Americans without health insurance by about 20 million over the last few years.

What the House Republican legislation and the Senate Republican legislation would do is eliminate those taxes. And that means pretty big tax cuts for some industries like the health insurance industry, the medical device industry and very large tax cuts for the wealthiest Americans who also were taxed at a higher level to help offset the cost of health insurance.

BLOCK: Noam Levey covers health care policy for the LA Times. Thanks again for coming in.

LEVEY: My pleasure. Transcript provided by NPR, Copyright NPR.