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Showing posts with label drumpf/trump-ryancare. Show all posts
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24 March 2017

GOP health-care bill: House Republican leaders abruptly pull their rewrite of the nation’s health-care law 24MAR17

stock photo of aca - Affordable Care Act Button A white button with red stripes and stars with words ACA isolated on a white background - JPG
VICTORY!!!! The repiglican leadership of the US House, rep fotze paul ryan r WI and the administration of (NOT MY) president drumpf/trump-pence have pulled their no health care bill, there will not be a vote, Obamacare stands! The republicans were not only defeated by the tea-baggers and freedom caucus and right wing extremest in their own party, they were also defeated by the American people who overwhelmingly disapproved of the drumpf/trump-pence-ryan plan. EVEN my representative, fotze barbara comstock r tb VA (10th cong dist) finally announced she would vote NO on the bill. Rest assured, her decision is political, she is looking at her re-election campaign in 2018, not care and compassion for her constituents. From +The Hill and the +Washington Post .....


Poll: Just 17 percent of voters back ObamaCare repeal plan

BY PAULINA FIROZI - 

Poll: Just 17 percent of voters back ObamaCare repeal plan
A majority of American voters oppose the Republicans' plan to repeal and replace ObamaCare, while very few voters support it, a new poll finds.
A poll published Thursday by Quinnipiac University found that 56 percent of voters disapprove of the GOP healthcare plan, while just 17 percent support it.
Even among Republicans, only 41 percent support the American Health Care Act, while 24 percent oppose it. And 58 percent of Democratic voters disapprove of the plan.
Republicans are scrambling to shore up support for the repeal-and-replace bill ahead of an expected House vote later Thursday. President Trump is meeting with members of the conservative Freedom Caucus, who are seeking a number of changes to the bill in exchange for their support.
But centrist Republicans are fleeing from the bill as it changes to fit the conservatives' desires, complicating efforts to get the bill passed in the House.
The poll found that 46 percent of voters say they will be less likely to vote for their Congressional representative if they vote to approve the GOP health insurance plan.
The Quinnipiac University poll was conducted from March 16 to 21 and surveyed 1,056 voters. The margin of error is 3 percentage points.
  

House Republican leaders abruptly pulled a Republican rewrite of the nation’s health-care system from consideration on Friday, a dramatic acknowledgment that they are so far unable to repeal the Affordable Care Act.
“We just pulled it,” President Trump told the Washington Post in a telephone interview.
The decision came a day after Trump delivered an ultimatum to lawmakers — and represented multiple failures for the new president and House Speaker Paul D. Ryan (R-Wis.).
The decision means the Affordable Care Act remains in place, at least for now, and a major GOP campaign promise goes unfulfilled. It also casts doubt on the GOP’s ability to govern and to advance other high-stakes agenda items, including tax reform and infrastructure spending. Ryan is still without a signature achievement as speaker — and the defeat undermines Trump’s image as a skilled dealmaker willing to strike compromises to push his agenda forward.
“I don’t blame Paul,” Trump said, referring to Ryan.
Rep. Bradley Byrne (R-Ala.), who planned to vote for the legislation, said that Friday would have been the “first big vote in the presidency of Donald Trump. I think it’s a statement, not just about him and the administration, but about the Republican Party and where we’re headed.”
“So much about political power is about perception. And if the perception is that you can’t get your first big initiative done, then that hurts the perceptions down the road about your ability to get other big things done,” Byrne said in an interview before the decision.
The decision came hours after Ryan visited the White House to warn Trump that despite days of intense negotiations and sales pitches to skeptical members, the legislation lacked the votes to pass.
Trump had personally lobbied 120 lawmakers, either in person or on the phone, White House press secretary Sean Spicer reminded reporters on Friday. The president had “left everything on the field,” Spicer said.
Spicer said that no matter what happens, the White House did not think that defeat would slow other parts of Trump’s agenda including tax reform and immigration reform.
Vice President Pence, White House Chief of Staff Reince Priebus and Health and Human Services Secretary Tom Price also made a last-ditch attempt to win over members of the hard-line House Freedom Caucus, huddling with them at midday at the Capitol Hill Club, a GOP social hall next door to the headquarters of the Republican National Committee. All three exited the meeting quickly without taking questions.
In one stunning defection Friday, House Appropriations Committee Chairman Rodney Frelinghuysen (R-N.J.) announced at midday that the health care bill is “currently unacceptable” and that changes made late Thursday to placate conservatives “raise serious coverage and cost issues.”
Another moderate, Rep. David Joyce (R-Ohio) — who had met with Trump on Wednesday night — said he would vote against the bill. So did Rep. Barbara Comstock (R-Va.), a longtime Ryan friend and ally who represents a competitive Northern Virginia congressional district.
Rep. Paul Gosar (R-Ariz.), a Freedom Caucus member, was one of six Republicans who voted against a procedural resolution bringing the bill to the floor on Friday morning.
“You know what? I came here to do health care right,” said Gosar, a dentist. “This is one chance we that can get one-sixth of our GDP done right. It starts with here.”
At the heart of the argument made by GOP leaders to skeptical members: Keeping the Affordable Care Act is a worse outcome than passing a potentially flawed replacement.
“You want to score a touchdown, but sometimes, on the fourth down, you kick a field goal,” said Rep. Joe Barton (R-Tex.), the longest-serving member of Congress in the Freedom Caucus. “The choice is yes or no. I’m not going to vote no and keep Obamacare. That’d be a stupid damn vote.”
At the White House on Friday morning, Trump projected confidence as he answered shouted questions following an announcement of a presidential permit for the Keystone XL pipeline, a revived project that the president said would create jobs.
Asked by a reporter what he would do if the bill fails, Trump — seated at his Oval Office desk — shrugged and said: “We’ll see what happens.”
Trump also said he didn’t feel the process had been rushed and that Ryan should remain as speaker if the bill fails.
On Twitter, Trump said that “After seven horrible years of ObamaCare (skyrocketing premiums & deductibles, bad healthcare), this is finally your chance for a great plan!”
With 237 House Republicans, party leaders can afford only 21 or 22 defections, depending on how many Democrats are present on Friday. If the measure fails, it would be a defeat for Trump in his first effort to help pass major legislation. An unsuccessful vote could also jeopardize other items on his wish list, including a tax overhaul and infrastructure spending.
No matter what happens in the House, the ultimate fate of the legislation hinges on the Senate, where new uncertainty emerged about the timing of a vote despite earlier guidance that Senate Majority Leader Mitch McConnell (R-Ky.) planned to push for a vote next week.
The Congressional Budget Office warned senators on Friday that recalculating the rewritten House bill could take a week or more to produce, said several officials familiar with the discussions, who were not authorized to speak publicly about the matter.
That was expected to upend McConnell’s plan to finish their work and send the legislation to the White House for Trump’s signature before a two-week Easter recess, according to three people briefed on the matter.
Senate budget rules require that party leaders provide an official estimate of how much the legislation would cost and how it would change the deficit before scheduling a vote.
McConnell’s aides didn’t immediately return requests for comment.
Republicans have a 52-to-48 advantage in the Senate, but at least a dozen Republicans are on the fence about the legislation, because many of them want to maintain some of the current law’s more generous spending components.
When formal debate on the bill began on Friday morning, top leaders used a procedural vote to gauge last-minute support. House Majority Whip Steve Scalise (R-La.) was seen conferring with Rep. Christopher Smith (R-N.J.), a key holdout. House Ways and Means Committee Chairman Kevin Brady (R-Tex.) sat in the row behind them cajoling Rep. Patrick Meehan (R-Pa.), another moderate who has yet to announce what he plans to do.
Rep. Mark Meadows (R-N.C.), who chairs the Freedom Caucus, did not respond to requests for comment on Friday about his plans.
Rep. Ken Buck (R-Colo), a caucus member who said before the election that minor losses in the House Republican ranks would increase conservative clout, said he remained undecided.
“I’m examining life experiences,” he said. Asked to explain what he meant, he said he was joking.
Rep. Peter King (R-N.Y.), a moderate who had expressed qualms as recently as Tuesday, when he was singled out by Trump inside a private meeting of House Republicans, said he had all but decided to vote for the bill.
“I’m not one they should worry about,” he said.
Rep. Louie Gohmert (R-Tex.), one of Trump’s most ardent congressional supporters, said he remained opposed to the legislation because it made more political sense to keep current law than to start rewriting it.
“A no vote means we save Donald Trump from a Democratic majority in 2019,” Gohmert said. “If this passes, then Obamacare stays.”
Republican leaders on Thursday introduced several tweaks intended to appeal to skeptics on either ideological flank. The amendment looks to appease moderates by adding $15 billion to a flexible fund for states to pay for maternity, mental health and substance abuse programs under Medicaid. That money adds to an existing $85 billion pot of money created by leaders earlier in the week.
The amendment attempted to appease conservatives by allowing states to determine the minimum standards for health insurance plans. It would allow insurers to drop basic coverage, like maternity care and preventative screenings, in order to cut premium rates.
Several members from both groups said the new additions were helpful but did not go far enough to win their votes. Moderate Rep. Leonard Lance (R-N.J.) told reporters Friday that he worries the bill still does not give states enough flexibility.
“I think there’s trouble with a significant number,” he said.
With Republicans in total control of the chamber, House Democrats could do little but clash and shout. A rare early-morning meeting of the Rules Committee held to set the rules of debate and add the amendment to the legislation quickly became tense.
“You never intended for there to be a health plan of consequence for this nation,” said Rep. Alcee Hastings (D-Fla.), raising his voice as he spoke.
He added: “What we will have done is helped rich people. And we will not have helped poor people.”
Rep. Greg Walden (R-Ore.), chairman of the House Energy and Commerce Committee and one of the bill’s architects, forcefully rejected Hastings’s claim during testimony before the rules panel, saying he was “offended” by the remark. He tried tempering the tone of his exchange with Hastings, who wouldn’t oblige
“I’m mad as hell about what you all are doing!” the Democrat exclaimed.
Later, Rep. Joe Crowley (D-N.Y.) told reporters that some Republicans were likely “ashamed” by a process that had been defined by “back-room deals,” turning an old Republican attack back onto the majority.
“For what? To keep a seven-year old campaign promise?” said Crowley. “So Trump doesn’t send a mean tweet about you? That’s not leadership; that’s politics.”
Sean Sullivan, David Nakamura, David Weigel, John Wagner and Paul Kane contributed to this report.
Mike DeBonis covers Congress and national politics for The Washington Post. He previously covered D.C. politics and government from 2007 to 2015.
  Follow @mikedebonis
Robert Costa is a national political reporter at The Washington Post.
  Follow @costareports
Ed O’Keefe is a congressional reporter who has covered congressional and presidential politics since 2008. He previously covered federal agencies, the federal workforce and spent a brief time covering the war in Iraq. Follow @edatpost.
  Follow @edatpost

POLITICAL MOJO FROM MOTHER JONES 24MAR17

KAISER FAMILY FOUNDATION REPORT: Premiums and Tax Credits Under the Affordable Care Act vs. the American Health Care Act: Interactive Maps & How Affordable Care Act Repeal and Replace Plans Might Shift Health Insurance Tax Credits 21&10MAR17


THE really fascinating thing about these maps is the areas of the country that went overwhelmingly for drumpf/trump-pence and the right wing fanatics of the republican party are the ones with the highest health insurance premium increases under the drumpf/trump-ryancare scheme. If this passes these people will be getting exactly what they voted for! From the +Kaiser Family Foundation .....

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

Mar 21, 2017
These maps compare county-level estimates of premiums and tax credits 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 were updated on March 21, 2017 to show estimates of how much a person buying their own insurance would have to pay under both the ACA and the House replacement bill. 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.
Note: This analysis does not take into account changes the House made on March 20 that would potentially allow for larger tax credits under the AHCA for people over age 50; it is not yet clear whether and how those funds would be allocated to tax credits. The map also does 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 less financial assistance under the AHCA. Additionally, older people would have higher starting premiums under the AHCA and would therefore pay higher premiums. Because younger people with higher-incomes and living in lower cost areas would receive more financial assistance and would have lower starting premiums on average, they would pay lower premiums on average.
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.
Our method of estimating premiums before tax credits under the AHCA is based on Congressional Budget Office (CBO) projections, which suggest that the premium for a 40-year-old under the AHCA would be similar to the premium for a 40-year-old under the ACA, before accounting for tax credits and for the same level of coverage. We therefore assume that the premium before tax credits for the second-lowest cost silver plan under the ACA is equal to the premium for a similar plan (with 70% actuarial value) under the AHCA for a 40-year-old. To arrive at the 60-year-old and 27-year-old premium under the AHCA, we use a 5:1 age curve, since the AHCA would change age rating from 3:1 to 5:1. We assume that states that have set their own age curves with ratios smaller than 3:1 (i.e. New York, Vermont, Massachusetts, and the District of Columbia) would maintain their state-specific age curves under the AHCA.
A second interactive map below displays the same information as in the first map, but with a focus on the share of one’s income that would be spent on a silver plan premium under both the ACA and the AHCA. Like the map above, it does not include cost-sharing assistance available for lower-income enrollees in the ACA, nor does it account for changes that may be made to increase the amount of financial assistance available to older enrollees in the AHCA.

How Affordable Care Act Repeal and Replace Plans Might Shift Health Insurance Tax Credits

Updated on March 10, 2017. Originally posted on March 1, 2017.
An important part of the repeal and replacement discussions around the Affordable Care Act (ACA) will involve the type and amount of subsidies that people get to help them afford health insurance.  This is particularly important for lower and moderate income individuals who do not have access to coverage at work and must purchase coverage directly.
The ACA provides three types of financial assistance to help people afford health coverage: Medicaid expansion for those with incomes below 138% of poverty (the Supreme Court later ruled this to be at state option); refundable premium tax credits for people with incomes from 100% to 400% of the poverty level who purchase coverage through federal or state marketplaces; cost-sharing subsidies for people with incomes from 100% to 250% of poverty to provide lower deductibles and copays when purchasing silver plans in a marketplace.
This analysis focuses on alternative ways to provide premium assistance for people purchasing individual market coverage, explaining how they work, providing examples of how they’re calculated, and presenting estimates of how assistance overall would change for current ACA marketplace enrollees.  Issues relating to changing Medicaid or methods of subsidizing cost-sharing will be addressed in other analyses.

Premium Tax Credits Under the ACA and Current Replacement Proposals

The ACA and leading replacement proposals rely on refundable tax credits to help individual market enrollees pay for premiums, although the credit amounts are set quite differently.  The House Leadership proposal released on March 6, the American Health Care Act, proposes refundable tax credits which vary with age (with a phase-out for high-income enrollees) and grow annually with inflation.  The tax credits under the ACA vary with family income and the cost of insurance where people live, as well as age, and grow annually if premiums increase.
These various tax credit approaches can have quite different implications for different groups of individual market purchasers.  For example, the tax credits under the ACA are higher for people with lower incomes than for people with higher incomes, and no credit is provided for individuals with incomes over 400% of poverty.  The current replacement proposal, in contrast, is flat for incomes up to $75,000 for an individual and $150,000 for a married couple, and so would provide relatively more assistance to people with upper-middle incomes.  Similarly, the ACA tax credits are relatively higher in areas with higher premiums (like many rural areas), while the replacement proposal credits do not vary by location.  If premiums grow more rapidly than inflation over time (which they generally have), the replacement proposal tax credits will grow more slowly than those provided under the ACA.
What is a Tax Credit, and How is it Different from a Deduction?
tax credit is an amount by which a taxpayer can reduce the amount they owe in federal income tax; for example, if a person had a federal tax bill of $2,500 and a tax credit of $1,000, their tax liability would be reduced to $1,500.  A refundable tax credit means that if the amount of the tax credit is greater than the amount of taxes owed, the taxpayer receives a refund of the difference; for example, if a person had a federal tax bill of $1000 and a tax credit of $1,500, they would receive a refund of $500.  Making the credit refundable is important if a goal is to assist lower-income families, many of whom may not owe federal income tax. An advanceable tax credit is made available at the time a premium payment is owed (which similarly benefits lower-income families so that they can receive the financial assistance upfront). The ACA and a number of replacement proposals allow for advance payment of credits.
A tax credit is different from a tax deduction.  A deduction reduces the amount of income that is taxed, while a credit reduces the amount of tax itself.  For example, if a person has taxable income of $30,000, a $500 deduction reduces the amount of taxable income to $29,500.  If the person’s marginal tax rate is 15%, the deduction reduces the person’s taxes by 15% of $500, or $75. Because people with lower incomes have lower marginal tax rates than people with higher incomes – and, typically don’t itemize their deductions – tax credits are generally more beneficial to lower income people than deductions.
The next section describes the differing tax credit approaches in more detail and draws out some of the implications for different types of purchasers.

How the Different Tax Credits Are Calculated

The ACA provides tax credits for individuals with family incomes from 100% to 400% of poverty ($11,880 to $47,520 for a single individual in 2017) if they are not eligible for employer-provided or public coverage and if they purchase individual market coverage in the federal or a state marketplace.  The tax credit amounts are calculated based on the family income of eligible individuals and the cost of coverage in the area where the live. More specifically, the ACA tax credit for an eligible individual is the difference between a specified percentage of his or her income (Table 1) and the premium of the second-lowest-cost silver plan (referred to as the benchmark premium) available in the area in which they live.  There is no tax credit available if the benchmark premium is less than the specified percentage of premium (which can occur for younger purchasers with relatively higher incomes) or if family income falls outside of the 100% to 400% of poverty range.  For families, the premiums for family members are added together (including up to 3 children) and compared to specified income percentages. ACA tax credits are made available in advance, based on income information provided to the marketplace, and reconciled based on actual income when a person files income taxes the following.
Table 1: Affordable Care Act Tax Credit Premium Cap, by Income in 2017
Income % PovertyPremium Cap (maximum % of income one must pay for second-lowest silver plan available to in their area)
Under 100%No Cap
100% – 133%2.04%
133% – 150%3.06% – 4.08%
150% – 200%4.08% – 6.43%
200% – 250%6.43% – 8.21%
250% – 300%8.21% – 9.69%
300% – 400%9.69%
Over 400%No Cap
Source: Kaiser Family Foundation
Take, for example, a person age 40 with income of $30,000, which is 253% of poverty.  At this income, the person’s specified percentage of income is 8.28% in 2017, which means that the person receives a tax credit if he or she has to pay more than 8.28% of income (or $2,485 annually) for the second-lowest-cost silver premium where he or she lives.  If we assume a premium of $4,328 (the national average benchmark premium for a person age 40 in 2017), the person’s tax credit would be the difference between the benchmark premium and the specified percentage of income, or $4,328 – $2,485 = $1,843 (or $154 per month).
The American Health Care Act takes a simpler approach and specifies the actual dollar amounts for a new refundable tax credit that could be used to purchase individual market coverage.  The amounts vary only with age up until an income of $75,000 for a single individual, at which point they begin to phase out. Tax credits range from $2,000 for people under age 30, to $2,500 for people ages 30 to 39, $3,000 for people age 40 to 49, $3,500 for people age 50 to 59, and $4,000 for people age 60 and over starting in 2020. Eligibility for the tax credit phases out starting at income above $75,000 for single individuals (the credit is reduced, but not below zero, by 10 cents for every dollar of income above this threshold, reaching zero at an income of $95,000 for single individuals up to age 29 or $115,000 for individuals age 60 and older). For joint filers, credits begin to phase out at an income of $150,000 (the tax credit is reduced to zero at an income of $190,000 for couples up to age 29; it is reduced to zero at income $230,000 for couples age 60 or older; and it is reduced to zero at income of $290,000 for couples claiming the maximum family credit amount). People who sign up for public programs such as Medicare, Medicaid, public employee health benefit programs, would not be eligible for a tax credit. The proposal further limits eligibility for tax credits to people who do not have an offer available for employer-provided health benefits.
Table 2 shows how projected ACA tax credits in 2020 compare to what would be provided under the American Health Care Act for people at various incomes, ages, and geographic areas. To show the ACA amounts in 2020, we inflated all 2017 premiums based on projections for direct purchase spending per enrollee from the National Health Expenditure Accounts. This method applies the same premium growth across all ages and geographic locations.  Note that the table does 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.
Table 2: Projected Annual Premium Tax Credit available in the Individual Market under the Affordable Care Act and the American Health Care Act, 2020
Income (2020 FPL)AgeAffordable Care ActAmerican Health Care Act
Reno, NVUS AverageMobile, ALReno, NVUS AverageMobile, AL
$20,000 (160% FPL)27$2,899$3,225$4,522$2,000$2,000$2,000
40$3,745$4,143$5,725$3,000$3,000$3,000
60$9,030$9,874$13,235$4,000$4,000$4,000
$40,000 (320% FPL)27$0$103$1,400$2,000$2,000$2,000
40$623$1,021$2,603$3,000$3,000$3,000
60$5,908$6,752$10,113$4,000$4,000$4,000
$75,000 (600% FPL)27$0$0$0$2,000$2,000$2,000
40$0$0$0$3,000$3,000$3,000
60$0$0$0$4,000$4,000$4,000
$100,000 (800% FPL)27$0$0$0$0$0$0
40$0$0$0$500$500$500
60$0$0$0$1,500$1,500$1,500
Source: Kaiser Family Foundation analysis. Notes: In the 2017 ACA exchange markets, premiums in Reno, NV and Mobile, AL are approximately representative of the 25th and 75th percentile, respectively. 2017 ACA premiums were increased according to National Health Expenditure projections for direct purchase. Under the ACA, people with incomes below 250% of the poverty level receive additional financial assistance for cost-sharing (not shown above).
Under the ACA in 2020, we project that a typical 40-year-old making $20,000 per year would be eligible for $4,143 in premium tax credits (not including the additional cost-sharing subsidies to lower his or her deductibles and copayments), while under the American Health Care Act, this person would be eligible $3,000. For context, we project that the average ACA premium for a 40-year-old in 2020 would be $5,101 annually (meaning the tax credit in the ACA would cover 81% of the total premium) for a benchmark silver plan with comprehensive benefits and reduced cost-sharing. A $3,000 tax credit for this same individual under the American Health Care Act would represent 59% of the average 40-year-old benchmark silver premium under the ACA.
Generally, the ACA has higher tax credit amounts than the replacement plan for lower-income people – especially for those who are older and live in higher-cost areas – and lower credits for those with higher incomes. Unlike the ACA, the replacement plan provides tax credits to people over 400% percent of the poverty level (phasing out around 900% of poverty for a single person), as well as to people current buying individual market coverage outside of the marketplaces (not included in this analysis).
While replacement plan tax credits vary by age – by a factor of 2 to 1 for older adults relative to younger ones – the variation is substantially less than under the ACA. The big differences in ACA tax credits at different ages is due to the fact that premiums for older adults can be three times the level of premiums for younger adults under the ACA, but all people at a given income level are expected to pay the same percentage of their income towards a benchmark plan. The tax credit fills in the difference, and this amount is much higher for older adults. These differences by age would be even further magnified under the American Health Care Act (which permits premiums to vary by a factor of 5 to 1 due to age). Before the ACA, premiums for older adults were typically four or five times the premiums charged to younger adults.

Figure 1: How House Republicans’ health reform plan might shift average health insurance tax credits, based on income and age, in 2020
The tax credits in the ACA vary significantly with premium costs in an area (see Table 2 and Figure 2). At a given income level and age, people receive bigger tax credits in a higher premium area like Mobile, Alabama and smaller tax credits in a lower premium area like Reno, Nevada. Under the ACA in 2017, premiums in Mobile, Alabama and Reno, Nevada approximately represent the 75th and 25th percentile, respectively.
The disparities between the ACA tax credits and those in the American Health Care Act will therefore vary noticeably across the country. For more on geographic differences between the ACA and the replacement plan, see Tax Credits under the Affordable Care Act vs. the American Health Care Act: An Interactive Map.

Figure 2: How House Republicans’ health reform plan might shift health insurance tax credits for a 40-year-old, by income & geography, 2020
The same general pattern can be seen for families as individuals, with lower-income families – and particularly lower-income families in higher-cost areas – receiving larger tax credits under the ACA, while middle-income families in lower-cost areas would receive larger tax credits under the American Health Care Act (Figure 3).

Figure 3: How House Republicans’ health reform plan might shift health insurance tax credits for a family of four, by income & geography, 2020
Figure 4 below shows how tax credits under the ACA differ from those in the American Health Care Act for a couple in their 60’s with no children. In this scenario, because premiums for older adults are higher and the ACA ties tax credits to the cost of premiums, a 60-year-old couple would receive larger tax credits under the ACA than the American Health Care Act at lower and middle incomes, but would receive a larger tax credit under the American Health Care Act at higher incomes.

Figure 4: How House Republicans’ health reform plan might shift health insurance tax credits for a 60-year-old couple, by income & geography, 2020

Estimates of Tax Credits Under the ACA and the American Health Care Act Over Time

We estimated the average tax credits that current ACA marketplace enrollees are receiving under the ACA and what they would qualify for if the American Health Care Act were in place.
Table 3: Average Annual Premium Tax Credit for Current Marketplace Enrollees under the Affordable Care Act (ACA) and the American Health Care Act 3-year, 5-year, and 10-year projections
 YearAffordable Care ActAmerican Health Care ActChange from ACA
2020 (3 years)$4,615$2,957-36%
2022 (5 years)$5,342$3,160-41%
2027 (10 years)$6,648$3,729-44%
Source: Kaiser Family Foundation analysis of data from Healthcare.gov, state-based exchanges, and Congressional Budget Office. Note: Amounts above represent the average tax credit received based on the age distribution of current Marketplace enrollees.
The average estimated tax credit received by ACA marketplace enrollees in 2017 is $3,617 on an annual basis, and that this amount will rise to $4,615 by 2020 based on projected growth rates from the Congressional Budget Office. This includes the 81% who receive premium subsidies as well as the 19% who do not.
We estimate – based on the age distribution of marketplace enrollees – that current enrollees would receive an average tax credit under the American Health Care Act of $2,957 in 2020, or 36% less than under the ACA (see Table 3 and Figure 3). While many people would receive lower tax credits under the Affordable Health Care Act, some would receive more assistance, notably the 19% of current marketplace enrollees who do not qualify for ACA subsidies.

Figure 5: Over time, the average tax credit received under Republican replacement plans would grow slower than under the ACA
While ACA tax credits grow as premiums increase over time, the tax credits in the American Health Care Act are indexed to inflation plus 1 percentage point. Based on CBO’s projections of ACA tax credit increases and inflation, the disparity between the average credits under the ACA and the two replacement plans would widen over time. The average tax credit current marketplace enrollees would receive under the American Health Care Act would be 41% lower than under the ACA in 2022 and 44% lower in 2027.

Discussion

Like the ACA itself, the American Health Care Act includes refundable tax credits to help make premiums more affordable for people buying their own insurance. This might seem like an area where a replacement plan could preserve a key element of the ACA. However, the tax credits are, in fact, structured quite differently, with important implications for affordability and which groups may be winners or losers if the ACA is repealed and replaced.
For current marketplace enrollees, the American Health Care Act would provide substantially lower tax credits overall than the ACA on average. People who are lower income, older, or live in high premium areas would be particularly disadvantaged under the American Health Care Act. People with incomes over 400% of the poverty level – including those buying individual market insurance outside of the marketplaces – do not get any financial assistance under the ACA but many would receive tax credits under the replacement proposal.
The underlying details of health reform proposals, such as the size and structure of health insurance tax credits, matter crucially in determining who benefits and who is disadvantaged