Insured Through Your Job? Medicaid? The ACA? Here's What Could Change For You
And because healthcare costs vary dramatically across the country, the ACA also gives more financial help to people who live in states where insurance tends to be more expensive.
The GOP formula, on the other hand, is based mainly on age, though in contradictory ways. On the one hand, it gives larger credits ($4,000) to people 60 and older, and smaller ones ($2,000) to those 30 and younger. But it also allows insurers to charge older people up to five times more than younger ones (vs. just three times more under the ACA).
The net result: Under the House plan, if you’re younger and healthy and live in places where healthcare is relatively inexpensive, insurance could be less expensive for you than under the ACA. In fact, the tax credits might fully cover your premiums and even leave extra to put away in a health savings account, says Timothy Jost, a health policy expert and emeritus professor at Washington and Law School of Law.
But if you’re older, poorer, or live in an area where healthcare is more expensive, the cost of insurance may be less affordable, according to an analysis comparing tax credits under the GOP plan and the ACA by the Kaiser Family Foundation, a nonpartisan, nonprofit research firm focused on health policy issues.
If You Get Insurance Through Your Job
The CBO report projects a larger impact on people with employer-based insurance than anticipated, where more than half of Americans get health coverage. About 7 million workers are expected to lose health insurance in the next decade under the House plan.
The impact is two-fold. Under the ACA, individuals who can have insurance through their employer but don’t take it face a penalty. Without that motivation, some people will choose not to get coverarge. In addition, the House bill would remove the penalty imposed by the ACA on companies with 50 or more employees if they did not offer insurance to their workers.
Although some employers complained about that penalty, saying that it was a job killer or costly, it did help many previously uninsured Americans get health insurance.
Jost says that companies with more than 200 employees—most of which offered insurance to workers even before the ACA—would probably continue to offer insurance, even without the penalty, because it helps them retain and attract workers.
But in an effort to save money, some companies with 50 to 200 employees might stop offering health insurance, Jost predicts. If you work at a company in that size range, you could find yourself having to decide whether to buy insurance on your own or go without.
Eventually, the House plan might also have another effect people who continue to get insurance through their employers. Though the GOP plan does away with almost all the taxes that fund the ACA, it does keep one: the so-called Cadillac tax on employers that offer generous healthcare coverage. Although that tax wouldn’t kick in till 2025, it could prompt your employer to offer less comprehensive coverage or plans where you shoulder more of the cost.
If You’re on Medicaid
The biggest group of people expected to see changes are those on Medicaid, the government health insurance program for low-income Americans. The CBO estimates that under the House plan, 14 million people will drop out of Medicaid coverage in the next decade because of changes to how the program is funded.
But those changes will come more gradually, with most occuring in 2020. If you’re getting health insurance through the Medicaid expansion program now, you’ll be grandfathered in and still receive it. But starting in 2020, if you have a break in coverage for more than one month you won’t be able to re-enroll.
In addition, the federal government now gives states money, allowing them to expand Medicaid to a broader group of low-income earners. As a result, more than 11 million people in 31 states newly qualified for coverage. The House bill proposes to freeze that expansion on Jan. 1, 2020, so you wouldn’t be be able to enroll after that date.
Another change is that the federal government currently matches what state’s put toward Medicaid, even if those costs continue to rise. But the GOP bill caps the amount of federal funding that states can receive. That would mean that when costs go up, states would either have to reduce coverage or come up with funds to offset the extra expense, according to a report by the Center on Budget Policies and Priorities, a nonpartisan research and policy institute.
Under the GOP plan, even if you remain in Medicaid there will be changes in your coverage. Now all insurance plans, including Medicaid, must cover 10 “essential” health services, including maternity coverage, prescription drugs, and mental healthcare. But under the GOP proposal, that requirement would go away starting in 2020.
“There are always trade-offs. The ACA had them, too,” Jost says. “This bill will help some people, but for millions of Americans who are dependent on Medicaid, this is very bad news.”
If You’re on Medicare
Medicare is separate and apart from the ACA insurance marketplaces, so the current House plan to repeal the ACA won’t cause Medicare premiums or co-pays to change.
But the GOP proposal still has some implications for people on Medicare, or at least those who hope to be in the future. That’s because the House bill eliminates virtually all taxes used to fund the ACA starting in 2018, including a 0.9 percent payroll tax on higher-income workers that funnels money into Medicare.
Without those funds, Medicare could be insolvent in 2024 and have to start reducing the amount of benefits it pays out—four years sooner than previously predicted, according to the AARP, a nonprofit organization that advocates on behalf of people 50 and older and analysis by the Center on Budget Policy and Priorities, a progressive think tank.
More from Consumer Reports:
Top pick tires for 2016
Best used cars for $25,000 and less
7 best mattresses for couples
Consumer Reports has no relationship with any advertisers on this website. Copyright © 2006-2017 Consumers Union of U.S.