Premiums and Tax Credits Under the Affordable Care Act vs. the American Health Care Act: Interactive Maps

These maps compare county-level estimates of premium tax credits consumers would receive under the Affordable Care Act (ACA) in 2020 with what they’d receive under the American Health Care Act as unveiled March 6 by Republican leaders in Congress.

The maps include premium tax credit estimates by county for current ACA marketplace enrollees at age 27, 40, or 60 with an annual income of $20,000, $30,000, $40,000, $50,000, $75,000, or $100,000. A downloadable spreadsheet of this data is available, as is a spreadsheet with family scenarios, including a family of four with two 40-year old adults and two children, as well as a 60-year-old couple with no dependent children. (Note: the map and spreadsheets do not include cost-sharing assistance under the ACA that lowers deductibles and copayments for low-income marketplace enrollees. For example, in 2016, people making between 100 – 150% of poverty enrolled in a silver plan on healthcare.gov received cost-sharing assistance worth $1,440; those with incomes between 150 – 200% of poverty received $1,068 on average; and those with incomes between 200 – 250% of poverty received $144 on average).

Generally, people who are older, lower-income, or live in high-premium areas (like Alaska and Arizona) receive larger tax credits under the ACA than they would under the American Health Care Act replacement.

Conversely, some people who are younger, higher-income, or live in low-premium areas (like Massachusetts, New Hampshire, and Washington) may receive larger assistance under the replacement plan.

Most current Healthcare.gov enrollees have lower incomes:

• About 66% of have incomes at or below 250% of poverty (approximately $31,250 for a single individual in 2020), with the bulk (44% of all enrollees) having incomes at or below 150% of poverty (approximately $18,750 in 2020).
• About 36% of enrollees are under age 35, 37% are age 35 to 54, and 27% are 55 or older.

Both the ACA and the American Health Care Act include tax credits in their approach. However, the law and the proposal calculate credit amounts differently: the ACA takes family income, local cost of insurance, and age into account, while the replacement proposal bases tax credits only on age, with a phase out for individuals with incomes above $75,000.

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If the AHCA can’t pass, what does @SpeakerRyan do next?

The House Republicans released the American Health Care Act (AHCA) on Monday. Aaron summarizes it here. Critics of the bill include all liberals, many conservatives, the major medical societies, and many health industry groups.

It will be challenging to pass the bill. On the one hand, Democrats will oppose it because it reduces taxes on people with high incomes while cutting Medicaid and health insurance subsidies. On the other hand, the conservative wing of the House Republicans may not support it because they view it as “Obamacare-lite“.

Nevertheless, the AHCA could pass Congress. Will House conservatives really vote against a bill that largely repeals the ACA? The House leadership is moving the AHCA forward as fast as possible, hoping they can pass it before opposition groups can mobilize. Senator McConnell can eliminate the filibuster rule so that the AHCA can be passed on a majority vote. He might then be able to hold his coalition together to get that majority.

But suppose conservatives refuse to support the AHCA and it is defeated in the House. What happens next?

Speaker Ryan will revise the bill to meet the conservatives’ demands and unite the Republican caucus. He’ll then pass the revised bill in the House. Here’s why.

First, although Ryan could conceivably pass a more liberal ACA replacement with Democratic votes, he won’t. Ryan believes what the conservatives believe. The current AHCA is his attempt to win just enough moderate Republican Senate votes to get the bill passed. The current AHCA was his move to the left, and he won’t make another one if it fails. Second, although Ryan’s in trouble if he can’t pass something, he’s finished as Speaker if he compromises with the Democrats on ACA repeal.

Ryan’s problem if he moves right is that a more conservative AHCA would probably lose moderate Senate Republican votes and be defeated in the Senate. However, that defeat would not cost Ryan his job and his credibility with the Republican base, and with them his prospects for enacting his legislative program. Moreover, the 2018 election has many Democratic seats at risk. If the Republicans take those seats and expand their Senate majority, the chances for a hard-right ACA repeal and replace bill get much better.

If I’m correct, the Democrats might think they are winning based on the critical reception of the AHCA, but they are actually in peril. They have to defeat the AHCA now and then win seats in 2018. The way to defeat the AHCA is to sustain and build the opposition to ACA repeal shown during the Congressional ‘town hall’ demonstrations this winter. They have to convince Republicans representing Blue districts and states that they are at risk if they vote for the AHCA.