ACA vs. AHCA: How They Stack Up

The Republican Congress began the year with a confident pledge to repeal the Affordable Care Act (ACA), emboldened by President Trump’s campaign pledge.

But the tune quickly changed, and instead of sounding the victory horns and lighting cigars with the burning remains of the ACA text, GOP lawmakers have struggled over the past months to craft a plan to replace the most significant health policy legislation in the past 50 years.

Then, on Monday, the House GOP released its long-awaited Obamacare replacement plan, titling it the American Health Care Act (AHCA).

It did not meet universal applause, even from Republicans, who are torn over many of its provisions. On one side, Colorado Sen. Cory Gardner and three other Republican senators are expressing concern over the proposed reduction in federal Medicaid funding. On the other side, Sen. Rand Paul and some House conservatives are deriding the bill as “Obamacare Lite.”

The new bill shows signs that last month’s town hall meetings — which were filled with jeers, boos, and angry constituents concerned about the future of their health care — appear to have had an effect.

Here at CHI, we have tracked half a dozen Republican proposals to replace the ACA since November 9, the day after the election. We have seen a lot of changes from the earlier proposals to the AHCA. For instance:

  • Former Rep. Tom Price’s 2015 plan included a steep penalty for dropping insurance: a 50 percent price hike for 18 months when people finally sign up for coverage. The AHCA instead specifies a one-year rate hike of 30 percent.
  • Speaker Paul Ryan’s 2016 plan limited the pre-tax dollars employers could spend on their employees’ health insurance premiums. After an uproar from employers saying this would increase the burden on their employees, the AHCA dropped any mention of limiting this benefit.
  • Republicans have long believed that mandating essential health benefits drives up the cost of insurance and is an overreach of government, but the AHCA maintains the ACA’s 10 essential health benefits that insurers must cover. 
  • Both the Price plan and the Ryan plan called for the repeal of the Medicaid expansion. But the expansion lives on (albeit heavily reformed) in the AHCA bill.

To be clear, the AHCA would still drastically change our health care system — Medicaid would be transitioned to a per capita system, and tax credits would be altered to reflect an enrollee’s age instead of their income. But the AHCA is not the start-over reform bill that Republicans have been calling for the last seven years.

We are releasing a graphic today (see below) comparing the AHCA with the ACA, showing how it would change the current system — and what it would stay the same.

And we’re hard at work to project the Colorado effects of the new legislation. We know the biggest changes would be to the state’s Medicaid members and the state budget for Medicaid. Stay tuned to CHI for more detailed analysis on this topic.

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Ian Pelto, this year’s Public Interest Fellow, graduated from Colorado College in May 2016 with a Bachelor of Arts degree in international political economy and a minor in biochemistry.