How does new Republican healthcare bill compare with ACA?

Republican lawmakers who introduced the proposed Healthcare Accessibility, Empowerment, and Liberty Act of 2016 (HAELA) on May 23 call it "the world's greatest healthcare bill ever," but an analysis in the Health Affairs blog isn't so sure.

At 117 pages, the bill introduced by Rep. Pete Sessions (R-Texas) and Sen. Bill Cassidy (R-La.) is far shorter and less complex than the Affordable Care Act it's meant to replace, according to the analysis, which contends that's part of the problem.

According to the analysis, there's not enough detail yet to know whether HAELA would increase or decrease coverage compared with the ACA. Some elements of HAELA should expand coverage, including universal tax credits, auto-enrollment by states into coverage plans or Roth health savings accounts, penalties for not maintaining continuous coverage, "and the availability of low cost (but low value) insurance." The bill also grandfathers those now covered by income-based tax credits and Medicaid expansion.

But the bill also:

  • Caps and then reduces Medicaid funding to states
  • Cuts eligibility levels for Medicaid
  • Limits access to income-based tax credits
  • Repeals mandates for individuals and employers
  • Encourages employers to drop tax exclusion subsidized employer-sponsored coverage

Premiums would be lower, but only because of limited benefit plans and "skimpy coverage plans" available with the repeal of the essential health benefit requirements, according to the report.

"In the end, the legislation, like most Republican proposals, would provide more generous help for wealthier Americans, who benefit most from tax shelters like [health savings accounts] and from flat dollar tax credits, but provide less help for the low-income Americans who have benefited most from the ACA and would have to pay substantially more for coverage and for care," according to the analysis.

To learn more:
- here's a copy of the bill (.pdf)
- see the Health Affairs analysis