WASHINGTON — House Republicans won passage of a revised bill Thursday rolling back much of former President Barack Obama’s health care law. The legislation would rework subsidies for private insurance, limit federal spending on Medicaid for low-income people and cut taxes on upper-income people that have been used to finance Obama’s overhaul.
The nonpartisan Congressional Budget Office estimates that the Republican bill will leave 24 million fewer people with health insurance by 2026 than under Obama’s 2010 statute.
Here are key elements of the bill:
• Ends tax penalties Obama’s law imposes on individuals who don’t purchase health insurance and larger employers who don’t offer coverage to workers.
• Halts extra payments Washington sends states to expand Medicaid to additional poorer Americans, and forbids states that haven’t already expanded Medicaid to do so. Changes Medicaid from an open-ended program that covers beneficiaries’ costs to one that gives states fixed amounts of money annually.
• Erases Obama’s subsidies for people buying individual policies, based mostly on consumers’ incomes and premium costs. Replaces them with tax credits that grow with age that must be used to defray premiums. The credits are refundable, which means they even go to people with little or no tax liability. Credits may not be used to buy policies that provide abortion coverage.
• Repeals Obama’s taxes on people with higher incomes and on insurance companies, prescription drug makers, some medical devices, expensive employer-provided insurance plans and tanning salons. Obama’s law uses the revenue to help pay for its expanded coverage.
• Requires insurers to apply 30 percent surcharges to customers who’ve let coverage lapse for more than 63 days in the past year. This would include people with pre-existing medical conditions.
• Lets states get federal waivers allowing insurers to charge older customers higher premiums than younger ones by as much as they’d like. Obama’s law limits the difference to a 3-1 ratio.
• States can get waivers exempting insurers from providing consumers with required coverage of specified health services, including hospital and outpatient care, pregnancy and mental health treatment.
• States can get waivers from Obama’s prohibition against insurers charging higher premiums to people with pre-existing health problems, but only if the person has had a gap in insurance coverage. States could get those waivers if they have mechanisms like high-risk pools that are supposed to help cover people with serious, expensive-to-treat diseases. Critics say these pools are often under-funded and ineffective.
• Provides $8 billion over five years to help states finance their high-risk pools. This late addition, aimed at winning over votes, is on top of $130 billion over a decade in the bill for states to help people afford coverage.
• Retains Obama’s requirement that family policies cover grown children to age 26, and its prohibition against varying premiums because of a customer’s gender.
Sources: U.S. Congress, The Associated Press, Kaiser Family Foundation
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