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What the Republican health plan might mean for your family
The Republican plan to replace the Affordable Care Act is finally here. What's in it for you and your family, who does it help, and who does it hurt? - photo by Jennifer Graham
After months of behind-the-scenes wrangling, Republicans have released a health-care plan they believe is better than what Americans got when President Barack Obama signed the Affordable Care Act in 2010.

Because the new plan, called the American Health Care Act, retains some key provisions of Obamacare, some pundits have dubbed it "Obamacare Lite."

But there are significant changes, including how health coverage for the poor is provided, leading many Democrats, several health organizations (including the American Medical Association) and even some Republicans to denounce the plan. House Minority Leader Nancy Pelosi tweeted that the proposal would "Make America Sick Again."

House Speaker Paul Ryan, however, called the plan an "act of mercy," BusinessInsider reported, that will drive down costs, encourage competition, and give every American access to quality, affordable health insurance."

Ryan expects the plan to go to a vote within two weeks, and he has said he "guarantees" it will have the 218 votes necessary for passage in the House. The plan needs 51 votes to pass the Senate.

Two legislative committees began reviewing the bill Wednesday, and the Congressional Budget Office has yet to weigh in on its potential costs, so the plan that comes up for a vote may be different from the one presented this week. For now, though, here are the answers to some questions you might have about how "Obamacare Lite" might affect your family.

Can my young-adult children stay on my insurance?

Yes, the Republicans kept the Affordable Care Act's provision that allows parents to provide health insurance for their young-adult children until age 26.

Will my employer still have to offer health insurance?

Officially, no. The ACA's mandate that large companies provide insurance for workers would be eliminated. Many companies, of course, will continue to provide health insurance for their workers as a perk, just as they did before Obamacare took effect. And the existing marketplaces where individuals can purchase insurance will continue, although some critics say that they may collapse in coming years.

I have cancer, or another condition. Can I still buy health insurance?

Yes, insurers cannot reject you because of a pre-existing condition, another holdover from the ACA. But they can charge you more than other people, based on your age.

Will the government help pay for my health insurance?

Sort of, but in a different way.

Obamacare's subsidies, which allowed some people to pay reduced monthly premiums, would end under the Republican plan. But the ACA's tax credits will be expanded, meaning more people will get money back at tax time if they have insurance, unless they opt to file early and have the credit sent to their insurer, The Wall Street Journal reported.

If your household earns less than $150,000 a year ($75,000 for individuals), you'll qualify for a tax credit between $2,000 and $4,000; how much depends on your age. (Older people get more of a credit than young adults.)

I'm on Medicaid. How will the Republican plan affect me?

This depends on where you live, and how much you earn. Under the ACA, about 10 million Americans became eligible for Medicaid when it was expanded in 31 states to allow families at 138 percent of the poverty level to qualify. (Utah was not among the states that changed eligibility.)

The Republican plan leaves that expansion intact until 2020; after that, qualifying reverts back to the way it was before the ACA. A bigger concern, both to the American Medical Association and some Republican senators in states where Medicaid was expanded, is how the Republican plan changes Medicaid's funding formula.

Medicaid, which covers one in five Americans, is administered by the states, with funding from the federal government that fluctuates according to need. (The states contribute, too.) But the new plan puts a cap on Medicaid spending, which some people say will hurt the poorest and sickest Americans. The changes to Medicaid are among the most controversial measures of the Republican plan, and their inclusion are "potentially more major than repealing the Affordable Care Act, Joan Alker, the executive director of the Center for Children and Families at Georgetown University, said in The New York Times.

Republicans who support the plan, however, point out that it provides $100 billion in grants that states can use over the next nine years to offer subsidies, provide preventive services and other forms of help for the poor and the sick.

How does this affect my health-savings account?

President Donald Trump is a fan of health-savings accounts, which allow people to set aside money tax-free for health-care expenses. His favor is reflected in the Republican proposal, which nearly doubles the amount of money you can set aside for medical expenses. For individuals, the amount rises from $3,400 to $6,550; for families, from $6,750 to $13,100.

What if I have trouble paying my premiums and decide to cancel my health-insurance policy to save money?

Under the ACA, if you did that, you'd pay a penalty at tax time. Under the Republican plan, the penalty comes when you decide to buy health insurance again. Then you'll be charged 30 percent extra for one year.

What groups of people benefit from this plan? Who is it most likely to hurt?

Most analysts say that young adults and mid-income families benefit the most from the GOP plan, because of the tax credits. Some say the poor are most likely to be hurt, especially if they drop health insurance to save money and later can't afford to buy coverage with a 30 percent penalty.

And older Americans may wind up paying more for their coverage. The ACA prevented insurers from charging older people more than three times the amount that they charged young people. In what the AARP calls an "age tax," the Republican plan lets them charge up to five times the amount; the figure will be set by the states.

Will my policy still offer maternity coverage? What about preventive visits, like well-child checkups?

The Affordable Care Act compelled insurers to offer 10 "essential benefits," which include maternity coverage and preventive care. The Republican plan leaves this mandate in place.

Can my insurance company set a cap on how much they spend on my health care?

No, just like the Affordable Care Act, the Republican plan prohibits insurers from setting caps, such as lifetime limits.

Do I get to keep my doctor?

If there was a defining question of the debate over Obamacare, this was it: Would you have to change doctors if you bought a plan through the government marketplace? For many people, the answer was yes, and their numbers increased as the number of players in the insurance marketplace shrank. It's too early to tell if this will improve under the Republican plan, but at least one analyst is hopeful.

In an article in STAT, Kathy Hempstead of the Robert Wood Johnson Foundation said expanded tax cuts for middle-income Americans might induce insurers to offer a wider range of plans, which would expand the numbers of doctors from which families can choose.

You would think there might be more variety, since some of these consumers would be willing to pay more for a plan. I would think there might be more variation in networks if this bill came to pass," Hempstead said.
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