Tag Archives: Medicaid Expansion

There’s one Obamacare repeal bill left standing. Here’s what’s in it.

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https://www.washingtonpost.com/graphics/2017/politics/cassidy-graham-explainer/?utm_term=.c90e0ce41aa2

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After a dramatic series of failed Senate votes in July, there’s one repeal-and-replace plan for the Affordable Care Act left standing. Trump is pushing for a vote, per Politico, and John McCain has announced his support, but the bill has yet to gain significant traction.

The proposal, crafted by Sens. Bill Cassidy (R-La.), Lindsey O. Graham (R-S.C.) and Dean Heller (R-Nev.), essentially turns control of the health-care markets over to the states. Rather than funding Medicaid and subsidies directly, that money would be put into a block grant that a state could use to develop any health-care system it wants. It also allows states to opt out of many ACA regulations. “If you like Obamacare, you can keep it,” Graham has said, using a common nickname for the health-care law. “If you want to replace it, you can.”

In reality, that may not be true. The Medicaid expansion and subsidy funding would be cut sharply compared to current spending, going to zero in a decade.

 “You can’t actually keep the same program if your federal funding is being cut by a third in 2026,” said Aviva Aron-Dine, a senior fellow at the left-leaning Center on Budget and Policy Priorities. And even putting aside the cuts, she said, the block grant structure would fundamentally change the health-care landscape. “[Funding] is capped, so it wouldn’t  go up and down with the economy,” when fewer or more people become eligible for subsidies.

Republicans contest this. The drop in funding “gives strong incentives for the states to be more efficient with their program,” said Ed Haislmaier, a senior fellow at the conservative Heritage Foundation. That is, states may be able to maintain the ACA structure and regulations as long as they streamline operations.

If the streamlining turns out to be insufficient, the cuts would hit liberal states the hardest, according to a report by the Center for Budget and Policy Priorities. This is largely because they tend to be the biggest spenders on health care: They’ve expanded Medicaid and aggressively signed people up for marketplace coverage. They have the most to lose.

 On the whole, Aron-Dine says, “This is a lot more similar to the [Senate repeal bill] than different. All of them end with devastating cuts to marketplace subsidies, Medicaid, and weakening of consumer protections.”

Haislmaier agreed, pointing out the Cassidy-Graham plan was originally intended as an amendment to the Senate bill.

Here’s the nitty gritty of what would change, compared to the ACA and the Senate plan that failed in July:

Who would need to be covered

Under the Cassidy-Graham plan, the mandates would be eliminated at the federal level. States could choose to keep the measure, replace it or get rid of it completely.

How they would pay for coverage

The federal health insurance subsidies that help most people with ACA marketplace plans afford their coverage would change. This bill would shift those subsidies to the state-level, so people in some states may see their subsidy scaled back or eliminated.

Proposed changes to Medicaid

The bill would restructure Medicaid and decrease its funding. That would make it very difficult for states to maintain the Medicaid expansion.

 

Medicaid fueling opioid epidemic? New theory is challenged

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http://abcnews.go.com/Health/wireStory/medicaid-fueling-opioid-epidemic-theory-challenged-49540513

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An intriguing new theory is gaining traction among conservative foes of the Obama-era health law: Its Medicaid expansion to low-income adults may be fueling the opioid epidemic.

If true, that would represent a shocking outcome for the Affordable Care Act. But there’s no evidence to suggest that’s happening, say university researchers who study the drug problem and are puzzled by such claims. Some even say Medicaid may be helping mitigate the consequences of the epidemic.

Circulating in conservative media, the Medicaid theory is bolstered by a private analysis produced by the Health and Human Services Department for Sen. Ron Johnson, R-Wis. The analysis says the overdose death rate rose nearly twice as much in states that expanded Medicaid compared with states that didn’t.

Independent experts say the analysis misses some crucial facts and skips standard steps that researchers use to rule out coincidences.

Johnson has asked the agency’s internal watchdog to investigate, suggesting that unscrupulous individuals may be using their new Medicaid cards to obtain large quantities of prescription painkillers and diverting the pills to street sales for profit. Diversion of pharmacy drugs has been a long-standing concern of law enforcement.

“These data appear to point to a larger problem,” Johnson wrote. “Medicaid expansion may be fueling the opioid epidemic in communities across the country.” He stopped just short of fingering Medicaid, saying more research is needed.

But if anything, university researchers say Medicaid seems to be doing the opposite of what conservatives allege.

“Medicaid is doing its job” by increasing treatment for opioid addiction, said Temple University economist Catherine Maclean, who recently published a paper on Medicaid expansion and drug treatment. “As more time passes, we may see a decline in overdoses in expansion states relative to nonexpansion states.”

Johnson is a conservative opponent of “Obamacare” who backed GOP efforts to curtail the Medicaid expansion. Wisconsin officials have urged him to push for changes in the health law to ensure the state wouldn’t be penalized for rejecting federal dollars to expand Medicaid.

Trump administration officials, including Health Secretary Tom Price and Seema Verma, head of the Centers for Medicare and Medicaid Services, have strongly criticized Medicaid, saying the program doesn’t deliver acceptable results.

Price’s agency would not answer questions about the analysis for Johnson, and released a statement instead.

“Correlation does not necessarily prove causation, and additional research is required before any conclusions can be made,” the statement said.

Translation: Just because something happens around the same time as something else, you can’t assume cause and effect. The statement said the administration is committed to fighting the opioid crisis.

Medicaid is a federal-state program that covers more than 70 million low-income people, from newborns to elderly nursing home residents and the disabled. Thirty-one states have expanded Medicaid to serve able-bodied adults, while 19 have not. The expansion went into effect in January, 2014, and the most recent national overdose death numbers are for 2015.

That leaves researchers with just a small slice of data. Both sides agree more research is needed.

Still, some patterns are emerging.

Prescriptions for medications used to treat opioid addiction in outpatient settings increased by 43 percent in Medicaid expansion states compared with states that didn’t expand, according to Maclean’s research with Brendan Saloner of Johns Hopkins Bloomberg School of Public Health. That indicates Medicaid is paying for treatment.

Maclean and Saloner also found another piece of the puzzle: Overdose death rates were higher to begin with in states that expanded Medicaid.

That’s important because it suggests that drug problems may have contributed to state decisions to expand Medicaid. States such as Ohio with high overdose rates might have wanted to leverage more federal money to help fight addiction

Maclean and Saloner looked at deaths from overdoses and fatal alcohol poisoning from 2010-2015, starting well before the Medicaid expansion. The HHS analysis for Sen. Johnson missed that underlying trend because it started with 2013 data.

When Gov. John Kasich, R-Ohio, talks about why he expanded Medicaid, “it has a lot to do with mental health and substance use disorders,” said Republican labor economist Craig Garthwaite of Northwestern University’s Kellogg School of Management.

Garthwaite finds the claim that Medicaid expansion fueled drug deaths “fundamentally flawed.”

Still another problem with the Medicaid theory is that it lumps all drug overdoses together. But illicit drugs — heroin and fentanyl — have been driving surges in deaths since 2010. A Medicaid card doesn’t provide access to illegal drugs.

“It’s worrisome because this is the type of numerical evidence that’s used to propose bad policy,” Garthwaite said.

Maclean, who reviewed the HHS analysis, said it seemed to rely on raw numbers without controlling for a range of differences among states, a standard technique.

Some researchers see hints that Medicaid expansion may be helping to mitigate the overdose epidemic.

Vanderbilt University economist Andrew Goodman-Bacon and Harvard’s Emma Sandoe drilled down to the county level in an informal analysis. From 2010 through 2015, counties with the largest insurance coverage gains experienced smaller increases in drug-related deaths than counties with smaller coverage gains.

More research is needed to provide conclusive evidence.

Relying on faulty research is “dangerous,” said Maclean. “It can lead to bad policies and people’s lives are at stake here.”

 

Medicaid Expansion Out of Pocket Spending Low Income

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http://www.commonwealthfund.org/publications/newsletters/ealerts/2017/aug/low-income-families-in-medicaid-expansion-states-have-much-lower-oop-spending?view=newsletter_email&email_web=true&omnicid=EALERT1260685&mid=henrykotula@yahoo.com

New Commonwealth Fund research out today demonstrates how states that expanded Medicaid eligibility have not only improved low-income residents’ access to health care but have also reduced what families must spend out of pocket on premiums, cost-sharing, and other related expenses.

Prior studies had shown that low-income residents of states that expanded Medicaid under the Affordable Care Act (ACA) are less likely to experience financial barriers to health care access. But the impact on people’s out-of-pocket spending had not been measured until now.

The new analysis, conducted by a team headed by Sherry Glied, dean of New York University’s Robert F. Wagner Graduate School of Public Service, found that the average low-income family in a Medicaid expansion state saves about $382 annually relative to a comparable family in a nonexpansion state. Moreover, low-income families in states that expanded Medicaid are less likely than their counterparts to have any out-of-pocket health care costs at all.

The authors say there was no statistically significant difference in outcomes for states that expanded through conventional Medicaid or through a waiver program.

http://www.commonwealthfund.org/publications/issue-briefs/2017/aug/medicaid-expansion-out-of-pocket-spending-low-income?omnicid=EALERT1260685&mid=henrykotula@yahoo.com

 

Coverage expansion and primary care access

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Coverage expansion and primary care access

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When you have a health problem, your first stop is probably to your primary care doctor. If you’ve found it harder to see your doctor in recent years, you could be tempted to blame the Affordable Care Act. As the health law sought to solve one problem, access to affordable health insurance, it risked creating another: too few primary care doctors to meet the surge in appointment requests from the newly insured.

Studies published just before the 2014 coverage expansion predicted a demand for millions more annual primary care appointments, requiring thousands of new primary care providers just to keep up. But a more recent study suggests primary care appointment availability may not have suffered as much as expected.

The study, published in April in JAMA Internal Medicine, found that across 10 states, primary care appointment availability for Medicaid enrollees increased since the Affordable Care Act’s coverage expansions went into effect. For privately insured patients, appointment availability held steady. All of the gains in access to care for Medicaid enrollees were concentrated in states that expanded Medicaid coverage. For instance, in Illinois 20 percent more primary care physicians accepted Medicaid after expansion than before it. Gains in Iowa and Pennsylvania were lower, but still substantial: 8 percent and 7 percent.

Though these findings are consistent with other research, including a study of Medicaid expansion in Michigan, they are contrary to intuition. In places where coverage gains were larger — in Medicaid expansion states — primary care appointment availability grew more.

“Given the duration of medical education, it’s not likely that thousands of new primary care practitioners entered the field in a few years to meet surging demand,” said the Penn health economist Daniel Polsky, the lead author on the study. There are other ways doctor’s offices can accommodate more patients, he added.

One way is by booking appointment requests further out, extending waiting times. The study findings bear this out. Waiting times increased for both Medicaid and privately insured patients. For example, the proportion of privately insured patients having to wait at least 30 days for an appointment grew to 10.5 percent from 7.1 percent.

The study assessed appointment availability and wait times, both before the 2014 coverage expansion and in 2016, using so-called secret shoppers. In this approach, people pretending to be patients with different characteristics — in this case with either Medicaid or private coverage — call doctor’s offices seeking appointments.

Improvement in Medicaid enrollees’ ability to obtain appointments may come as a surprise. Of all insurance types, Medicaid is the least likely to be accepted by physicians because it tends to pay the lowest rates. But some provisions of the Affordable Care Act may have enhanced Medicaid enrollees’ ability to obtain primary care.

The law increased Medicaid payments to primary care providers to Medicare levels in 2013 and 2014 with federal funding. Some states extended that enhanced payment level with state funding for subsequent years, but the study found higher rates of doctors’ acceptance of Medicaid even in states that didn’t do so.

The Affordable Care Act also included funding that fueled expansion of federally qualified health centers, which provide health care to patients regardless of ability to pay. Because these centers operate in low-income areas that are more likely to have greater concentrations of Medicaid enrollees, this expansion may have improved their access to care.

Other trends in medical practice might have aided in meeting growing appointment demand. “The practice and organization of medical care has been dynamic in recent years, and that could partly explain our results,” Mr. Polsky said. “For example, if patient panels are better managed by larger organizations, the trend towards consolidation could absorb some of the increased demand.”

Although the exact explanation is uncertain, what is clear is that the primary care system has not been overwhelmed by coverage expansion. Waiting times have gone up, but the ability of Medicaid patients to get appointments has improved, with no degradation in that aspect for privately insured patients.

Doctor Shortage Under Obamacare? It Didn’t Happen

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When you have a health problem, your first stop is probably to your primary care doctor. If you’ve found it harder to see your doctor in recent years, you could be tempted to blame the Affordable Care Act. As the health law sought to solve one problem, access to affordable health insurance, it risked creating another: too few primary care doctors to meet the surge in appointment requests from the newly insured.

Studies published just before the 2014 coverage expansion predicted a demand for millions more annual primary care appointments, requiring thousands of new primary care providers just to keep up. But a more recent study suggests primary care appointment availability may not have suffered as much as expected.

The study, published in April in JAMA Internal Medicine, found that across 10 states, primary care appointment availability for Medicaid enrollees increased since the Affordable Care Act’s coverage expansions went into effect. For privately insured patients, appointment availability held steady. All of the gains in access to care for Medicaid enrollees were concentrated in states that expanded Medicaid coverage. For instance, in Illinois 20 percent more primary care physicians accepted Medicaid after expansion than before it. Gains in Iowa and Pennsylvania were lower, but still substantial: 8 percent and 7 percent.

Though these findings are consistent with other research, including a study of Medicaid expansion in Michigan, they are contrary to intuition. In places where coverage gains were larger — in Medicaid expansion states — primary care appointment availability grew more.

“Given the duration of medical education, it’s not likely that thousands of new primary care practitioners entered the field in a few years to meet surging demand,” said the Penn health economist Daniel Polsky, the lead author on the study. There are other ways doctor’s offices can accommodate more patients, he added.

One way is by booking appointment requests further out, extending waiting times. The study findings bear this out. Waiting times increased for both Medicaid and privately insured patients. For example, the proportion of privately insured patients having to wait at least 30 days for an appointment grew to 10.5 percent from 7.1 percent.

The study assessed appointment availability and wait times, both before the 2014 coverage expansion and in 2016, using so-called secret shoppers. In this approach, people pretending to be patients with different characteristics — in this case with either Medicaid or private coverage — call doctor’s offices seeking appointments.

Improvement in Medicaid enrollees’ ability to obtain appointments may come as a surprise. Of all insurance types, Medicaid is the least likely to be accepted by physicians because it tends to pay the lowest rates. But some provisions of the Affordable Care Act may have enhanced Medicaid enrollees’ ability to obtain primary care.

The law increased Medicaid payments to primary care providers to Medicare levels in 2013 and 2014 with federal funding. Some states extended that enhanced payment level with state funding for subsequent years, but the study found higher rates of doctors’ acceptance of Medicaid even in states that didn’t do so.

The Affordable Care Act also included funding that fueled expansion of federally qualified health centers, which provide health care to patients regardless of ability to pay. Because these centers operate in low-income areas that are more likely to have greater concentrations of Medicaid enrollees, this expansion may have improved their access to care.

Other trends in medical practice might have aided in meeting growing appointment demand. “The practice and organization of medical care has been dynamic in recent years, and that could partly explain our results,” Mr. Polsky said. “For example, if patient panels are better managed by larger organizations, the trend towards consolidation could absorb some of the increased demand.”

Although the exact explanation is uncertain, what is clear is that the primary care system has not been overwhelmed by coverage expansion. Waiting times have gone up, but the ability of Medicaid patients to get appointments has improved, with no degradation in that aspect for privately insured patients.

Republican plan to ‘repeal and delay’ will leave millions more Americans uninsured

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http://www.politico.com/interactives/2017/republican-obamacare-repeal-uninsured-double/?lo=ap_a1

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Majority Leader Mitch McConnell wants to hold a vote on a bill that would repeal major parts of Obamacare and give Republicans two years to pass a replacement. A new CBO report finds that repealing Obamacare without a replacement would result in 32 million more Americans losing health insurance over a decade — far deeper coverage losses than any of the health plans Republicans have proposed. Further, 75 percent of Americans would live in areas without any insurers selling coverage in the individual market by 2026.

The latest GOP health plan would strike:

  •  Individual mandate
  •  Insurance subsidies
  •  Medicaid expansion
  •  Planned Parenthood funding

The bill would effectively kill Obamacare’s individual and employer coverage mandates, strike health insurance subsidies, roll back Medicaid expansion and defund Planned Parenthood.

Repealing Obamacare would more than double the number of Americans without health insurance.

Under Obamacare, 10 percentof Americans would lack health insurance.

But if Republicans repeal Obamacare, the number could grow to 21 percent by 2026.

NOTE: Data includes Americans under 65 who do not have health insurance and does not include persons who are Medicare-eligible.
SOURCE: Congressional Budget Office

The uninsured rate plunged under the ACA, but would now skyrocket

ACARepeal ACA0510152025%1997201020172026Before the ACAACA passed10%21%
NOTE: Data includes Americans under 65 who do not have health insurance
SOURCE: National Center for Health Statistics and the Congressional Budget Office

In the first year alone, nearly 17 million more people would no longer have insurance — or (16 percent) of Americans. That includes 10 million fewer buying plans on the individual market, 4 million fewer people covered through Medicaid, and 2 million fewer with job-based coverage.

But once Medicaid expansion and subsidies were repealed (roughly two years after enactment), the number of uninsured Americans would increase by 27 million in 2020. By 2026, about 59 million people or 21 percent of Americans would be uninsured.

The Senate Puts Medicaid on the Chopping Block

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https://www.theatlantic.com/politics/archive/2017/06/ahca-senate-draft-medicaid-changes/531231/

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A draft version of the AHCA released Thursday shows even deeper cuts to the program than the House version.

The new AHCA is a lot like the old AHCA.

After weeks of secret gestation in back rooms, the Senate released a discussion draft of the chamber’s version of the American Health Care Act. Like the version passed through the House to cheers in May, it is likely to make health care less affordable for low-income, sick, and near-elderly people; it makes Obamacare tax credits for exchange coverage less generous; it restricts and slashes Medicaid funding deeply over the next decade; and it attempts to smooth euphemistically-named “market disruptions” from all those reforms by injecting billions into state funds and reinsurance.

There are some substantial changes in the specifics, though. For starters, the Senate bill would tweak the House bill’s tax subsidy for private insurance purchased on the exchanges. The final version of the House bill provided a tax credit to people making up to 400 percent of the federal poverty line that would be less generous than the existing ACA credits. It would also reduce the amount of expenses covered as recipients get older and have more expenses.

The Senate’s version would cut the eligibility for premium tax credits to those earning up to 350 percent of the poverty line. It would be slightly more generous for poor and near-poor people, although credit percentages would taper off more sharply as recipients grow older, and they would be severely restricted for people as their income approaches that 350 percent threshold. Unlike the House plan, however, the Senate plan would fund Obamacare exchange cost-sharing subsidies through 2019, which would soften some of the immediate impacts of a less generous tax credit.

The House’s bill would allow private insurers to charge people more as they grow older, and permit plans in certain states to cover fewer services. It also would have made exchange coverage more expensive and less comprehensive on average for low-income, sick, and older people. It would likely reduce coverage for pregnant women and people with mental-health issues as well. The last Congressional Budget Office score found that many of the 23 million fewer people who would be covered were drawn from those groups, as well as many of those who would keep coverage but suffer dramatic increases in premiums.

The Senate bill would alleviate some of these issues with slightly more generous credits for the poor, but would keep those central disruptions intact, and would leave more middle-class people without affordable coverage. It also allows even less generous plans to stand as benchmarks for exchange and employer coverage, which could likewise contribute to disruptions and deductible increases.

In recognition of the disruptions to the state-level exchanges through which individuals purchase coverage, the House bill set up a “Patient and State Stability Fund,” which would inject over $100 billion into state high-risk pools and reinsurance funds. The Senate largely replicates this approach with slightly less funding, although it does add an additional $2 billion fund for fighting the opioid crisis in 2018.

The much more drastic changes in the Senate bill as compared to the House bill come in the realm of Medicaid. The House bill immediately ended enhanced funding for the Medicaid expansion to able-bodied low-income adults under the ACA, while the Senate bill would slowly phase that funding out. This, in theory, would put millions fewer people immediately in the ranks of the uninsured and increase government spending over the House plan. But seven states (Arkansas, Illinois, Indiana, Michigan, New Hampshire, New Mexico, and Washington) have “trigger laws” that would immediately void their Medicaid expansions with any change in federal support, and it’s likely more states would choose to shutter their expansions well before the end of the enhanced funding window in the face of rising costs.

Several independent analyses have concluded that this funding structure would lead to large-scale shortfalls in every state, which would need to be closed by reducing enrollment or benefits, and cutting capacity to respond to disasters and public-health crises. Those affected most would be poor children, people with mental-health issues, and disabled people.

After President Trump reportedly called the House draft “mean” earlier this month, many observers expected the Senate to produce a more moderate plan. Instead, the Senate plan actually deepens long-term Medicaid cuts. The bill keeps the same basic inflationary index of the House bill until 2025. But after that, instead of using the more generous medical inflationary index (since costs in the health-care sector increase faster than broader measures of inflation), the Senate plan uses the general Consumer Price Index for all urban consumers (CPI-U), which will dramatically slow the rate at which funding for the program increases.

A recent report from the Urban Institute shows some of the long-term effects of this switch in inflationary indexes. While it assumes an existing Medicaid expansion and compares an immediate difference in indexing, instead of the 2025 phase-in, the paper illustrates how Medicaid funding will be flattened in the future under the CPI-U. States will have to plan for much less generous Medicaid funding down the road, and most signs point to even more cuts in benefits and eligibility for some of the most vulnerable populations than under the House plan.

That restriction on Medicaid might seem like bad politics, and it remains to be seen if moderate Republicans will warm to the bill, or if public pressure will change some minds. But among the Republican base especially, Medicaid remains deeply unpopular, and is frequently maligned. Even as strengthening the private-insurance subsidies became a key issue for Senate Republicans, Medicaid remained a target, and reducing its generosity has long been a rather uncontroversial piece of the party’s goals.

The full impact of all these changes in the Senate draft won’t be known until it receives a score from the CBO. But what appears clear is that along with broad cuts in Obamacare taxes that mostly benefit middle-class and upper-income people, the Senate plan—perhaps even more so than the House plan—is a massive constriction of the safety net. It will have a substantial impact on both wealth and health, shifting the benefits of public policy away from the poor and the sick, and toward the healthy and the affluent. For Republicans who have long despised the redistributive effects of Medicaid, that is precisely the point.

The Health 202: Here’s what’s in the Senate health-care bill

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https://www.washingtonpost.com/news/powerpost/paloma/the-health-202/2017/06/22/the-health-202-here-s-what-s-in-the-senate-health-care-bill/594aa367e9b69b2fb981dde9/?utm_term=.fd77d3f3481a

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The Senate version of the repeal (and “replacement”) of the Affordable Care Act — which Mitch McConnell is now sharing with Senate Republicans — eliminates just about all of its extra taxes on the rich by deeply cutting Medicaid and reducing subsidies to the poor. But McConnell figures he can keep moderate Republicans in the fold (he needs almost all their votes) by delaying these provisions and allowing states to reduce insurance coverage.

The plan:

1. Basically retains Obamacare’s insurance subsidies. But starting in 2020 this assistance wouldn’t be available for most of the working-class who now receive them, nor for anyone ineligible for Medicaid. See #2.

2. Cuts Medicaid more deeply than the House version by giving states an amount per person that grows more slowly than the growth in healthcare costs. This provision won’t kick in for 7 years, well past senators’ next reelection battles.

3. Ends the Affordable Care Act’s Medicaid expansion in 5 years — gradually reducing the extra federal payments starting in 2021.

4. Continues to protect patients with preexisting conditions, but allows states to reduce insurance coverage to everyone, including people with preexisting conditions.

In other words, all cuts are made through the back door of delays and state waivers. It only looks like a kinder, gentler version of the House repeal of the Affordable Care Act — but 7 to 10 years from now its result would be even crueler.

The Senate health bill is out. Here’s your speed read

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https://www.axios.com/the-senate-bill-is-out-heres-your-speed-read-2446201141.html

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You can read it here, and a summary here. The highlights:

  • Ends the Affordable Care Act’s mandates and most of its taxes.
  • Phases out its Medicaid expansion over three years, ending in 2024.
  • Limits Medicaid spending with per capita caps, or block grants for states that choose them. The spending growth rate would become stricter in 2025.
  • States could apply for waivers from many of the insurance regulations.
  • The ACA’s tax credits would be kept in place, unlike the House bill — but their value would be reduced.
  • Funds the ACA’s cost-sharing subsidies through 2019, but then repeals them.

Want more? Keep reading.

  • There’s a stabilization fund to help states strengthen their individual health insurance markets.
    • $15 billion a year in 2018 and 2019, $10 billion a year in 2020 and 2021.
    • There’s also a long-term state innovation fund, $62 billion over eight years, to help high-cost and low-income people buy health insurance.
  • The ACA tax credits continue in 2018 and 2019.
  • After that, they’d only be available for people with incomes up to 350 percent of the poverty line.
  • The “actuarial value” — the amount of the medical costs that insurance would have to cover — would be lowered to 58 percent, down from 70 percent for the ACA’s benchmark plans. That’s likely to reduce the value of the tax credits.
  • All ACA taxes would be repealed except for the “Cadillac tax” for generous plans, which would be delayed.
  • Medicaid spending growth rate under per capita caps would be same as House bill until 2025. Then it switches to the general inflation rate, which is lower than House bill.
  • States would be able to impose work requirements for people on Medicaid, except for the elderly, pregnant women and people with disabilities.
  • Children with complex medical needs would be exempt from the per capita caps.

ObamaCare: Six key parts of the Senate bill

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ObamaCare: Six key parts of the Senate bill

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While Senate Republicans are drafting their healthcare plan behind closed doors, they’ve given reporters a general idea of what might be in it.

The bill is shaping up to have a similar structure as the House’s bill, while more reflecting the principles of centrist Republicans in both chambers.

Senators are still hashing out the specifics, but here’s a look at where they appear to be headed.