Obamacare Vs. American Health Care Act: Here's Where They Differ

NPR looks at how the Affordable Care Act and American Health Care Act differ in terms of insurance marketplaces, the individual mandate, guaranteed coverage and insurance subsidies.

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KELLY MCEVERS, HOST:

Health care, repeal and replace, the ACA, the AHCA - what does it all mean, and how does it affect you? We're going to spend some time talking about this, about what is still the law of the land - and that is the Affordable Care Act - and how that compares to what House Republicans passed yesterday. Here is how House Speaker Paul Ryan describes the American Health Care Act.

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PAUL RYAN: It makes health care more affordable. It takes care of our most vulnerable. And it shifts power from Washington back to the states and, most importantly, back to you, the patient.

MCEVERS: And let's be clear. This bill is not law yet. It still has to go through the Senate where it's likely to change quite a bit. But people still have a lot of questions. And we're going to hear from people from around the country in a few minutes. But first let's just lay out the differences between the Affordable Care Act and the American Health Care Act with Alison Kodjak. She covers health for NPR's science desk. Hi there.

ALISON KODJAK, BYLINE: Hi, Kelly.

MCEVERS: So first just talk about what's in this bill.

KODJAK: The main point of difference are that under the Affordable Care Act or Obamacare, everybody is required to buy insurance, or they have to pay a penalty. Obamacare also offers pretty generous subsidies to help lower-income people pay for their premiums and also to buy down some of their costs like deductibles.

In the Republican bill, there's no such requirement. People don't have to have insurance. If they don't have insurance and then they want to buy in later, they'll have to pay a penalty. But they don't have to have insurance every year. And there are smaller subsidies to help them pay for insurance for most people.

MCEVERS: So smaller subsidies - doesn't that mean fewer people will buy in?

KODJAK: Well, Republicans argue that their bill makes premiums fall, that it'll cost less, so more people will actually be able to buy insurance. That's in part because they let insurance companies charge people five times more if they're older than the youngest people. And so prices for younger and healthy people can drop.

MCEVERS: So what about quality? I mean we're hearing people who are worried that their insurance just won't be as good.

KODJAK: Yeah. That's been a big issue, and it's taken up a lot of debate here in Washington. Under Obamacare, there are a lot of consumer protections. Insurance companies have to cover a lot of things, including mental health, prescription drugs, maternity care. And it's required to cover people with pre-existing conditions with no extra costs. And there's no lifetime limits on coverage, no annual limits.

Under the new bill, states are allowed to opt out of most of those protections. So if you live in a state that gets those waivers and you end up sick, you may end up in what's called a high-risk pool, a separate insurance plan for people who have illnesses that cost a lot of money to cover.

MCEVERS: And what about the poor? I mean, this new bill includes cuts to Medicaid, the program that benefits the poor. Is that right?

KODJAK: Yeah. And that's a big change, too. Under Obamacare, Medicaid was expanded to people who are slightly over the poverty line. This bill rolls back most of that expansion, and it also cuts spending on Medicaid by almost $800 billion over 10 years. So there could be a lot of changes in what's covered under Medicaid if this bill becomes law.

MCEVERS: NPR's Alison Kodjak, thank you very much.

KODJAK: Thanks, Kelly.

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