There's plenty that we know about the Republicans' new healthcare bill to repeal and replace the Affordable Care Act, but there's also plenty that we don't. The GOP — seemingly wary of what the numbers would say — made their plan public without running it by the Congressional Budget Office. Normally the office would give it's take on the financial implications and more of any bill. Not this time. So what are the questions that the Obamacare replacement bill leaves unanswered? Some of the biggest and most important in healthcare reform. Especially if the goal is full coverage.
Some of the most controversial aspects have been addressed, if not to the high standard set forth in Obamacare. Young adults would still be covered under their parents plans until 26 — that's not going anywhere. The other popular feature, prohibiting discrimination against those with preexisting conditions also stays, somewhat. It would require they not have a gap in coverage over 63 days. If so, there would be a 30 percent premium surcharge.
Also, tax credits to help you buy private insurance are here to stay, but they'll be smaller and tied to your age, not your income. So you may no longer be able to afford the private plans, even if you make too much money to qualify for Medicaid. And then there's the questions that go unanswered.
How many people will lose their insurance?
This would be one of the biggest things to learn from the CBO report on the bill. The goal of Obamacare was full coverage. Either you qualified for Medicaid or were provided a subsidy for private coverage. But now the gap between affordable private care and Medicaid coverage could increase.
One reason is that the subsidies will be smaller. Your income and geographic location aren't taken into consideration. So that means that if you're young, working a low-paying job, and live somewhere with high health insurance costs like New York, you won't be able to afford insurance.
How many people will be in this situation? No one knows yet because the CBO wasn't able to study the bill before its introduction. But some original looks at a full Obamacare repeal pointed to 18 million losing their coverage, and it's safe to say the number could be in the millions.
Is Medicaid safe?
4 GOP sens warn they will NOT vote for Obamacare bill that doesn't protect Medicaid expansion recipients:— Steven Dennis (@StevenTDennis) March 6, 2017
There's been a lot of talk about the Medicaid expansion, which was the other key part of Obamacare, being in danger. For those not able to afford a private plan, even with subsidies, the Medicaid eligibility was expanded to include people above the poverty line, but at income level that most would still consider poor. There were 11 million people who gained insurance as a result, and there would have been more if it weren't for the GOP.
Not only are those newly insured under at risk, but the entire Medicaid program is being reconfigured. Instead of the federal government guaranteeing it will pay for coverage provided by the states, it would give states a set amount of money. That could force states to remove people from their insurance rolls, or make up the difference themselves. But how it will go is an open question, because each state will respond differently.
How much will it cost?
Ill try to explain this one more time: When u cut subsidies, ppl lose insurance. W/o insurance, they use ERs. Uncompensated care paid by u.— Kurt Eichenwald (@kurteichenwald) February 28, 2017
There's no estimate from the CBO about how much the bill will cost taxpayers, and the comparison with Obamacare would be an important consideration. Until the last iteration, it seemed that the rich would also be eligible for tax credits. That's not the case now, but costs should be taken into affect. And if there's not much overall saving, why take healthcare away from millions of people?
Will it rein in healthcare spending?
Even if you don't lose insurance under House GOP's repeal plan, you'll still pay for those who do. https://t.co/CJF5mfziRa— Caroline O. (@RVAwonk) March 7, 2017
This is something to take into consideration above and beyond the pure cost of the bill. A big goal of Obamacare was to rein in overall healthcare spending, because it has grown as a percentage of GDP spending for decades. But will the GOP repeal and replace also lower costs? Maybe not, says at least one Republican representative.
"The biggest concern I have is, will it lower healthcare costs?" Rep. Mark Meadows told Sean Hannity Monday night. Meadows said he won't comment on the bill until he gets a clear answer on this issue.
You can bet that Democrats will be making a big deal about these issues as they fight to protect Obamacare. The GOP has kept these details quiet precisely to avoid having that conversation while they build support for the bill. The numbers will come out eventually, though, and it's likely to be a reckoning.
Plus, with four Republican senators refusing to support as is, GOP leadership has a long way to go before finding a repeal and replace plan that will pass through Congress — let alone help every American have health insurance.