Senate Republican leaders unveiled their health-care bill Thursday morning, after weeks of crafting it behind closed doors. The bill, like the House’s, makes steep spending cuts to Medicaid and insurance subsidies, and uses the savings to fund a substantial tax cut for the health-care industry and wealthier Americans.
The subsidy cuts fall disproportionately on lower-income and older Americans. Those who live in rural areas, where health-care costs tend to be higher, also stand to pay higher premiums, especially in the House bill, according to two analyses by the Kaiser Family Foundation.
Senate bill cuts subsidies for low-income Americans, but not as much as House bill
Under the ACA, the subsidies go to people making under 400 percent of the poverty line — about $42,000 for an individual or $98,400 for a family of four — with more money going to people who are lower-income, older or living in higher-cost areas.
The Senate bill keeps this overall structure, but by adjusting subsidy numbers and implementing policies that are projected to increase premiums, low-income people by and large end up with higher health-care costs.
HOW MUCH PEOPLE WOULD PAY FOR
ANNUAL PREMIUMS, COMPARED TO
THE ACA
PAY MORE BY:
$3,000
$2,000
$1,000
PAY LESS BY:
No change
$1,000
No data
HOW MUCH PEOPLE WOULD PAY FOR ANNUAL PREMIUMS, COMPARED TO THE ACA
PAY MORE BY:
PAY LESS BY:
$3,000
$2,000
$1,000
No change
$1,000
No data
27 years old, $30,000 income
House bill
Senate bill
Young, low-income people in the midwest see lower savings than under the House bill.
40 years old, $20,000 income
House bill
Senate bill
For middle-aged, low-income people, the same places bear the brunt of the premium increases, but the change is smaller overall.
Young, low-income people in the midwest see lower savings than under the House bill.
House bill
Senate bill
27 years old
$30,000 income
40 years old
$20,000 income
For middle-aged, low-income people, the same places bear the brunt of the premium increases, but the change is smaller overall.
House bill
Senate bill
27 years old
$30,000 income
Young, low-income people in the midwest see lower savings than under the House bill.
40 years old
$20,000 income
For middle-aged, low-income people, the same places bear the brunt of the premium increases, but the change is smaller overall.
Compared to the Senate bill, the House bill upends the ACA’s structure entirely, basing subsidies primarily on age, rather than age, income and geography. That means some higher-income Americans would get subsidies under their plan. Under the Senate bill, higher-income people would continue to not receive subsidies.
40 years old, $75,000 income
House bill
Senate bill
Higher-income Americans get subsidies under the House bill, but not the Senate bill.
House bill
Senate bill
40 years old
$75,000 income
Higher-income Americans get subsidies under the House bill, but not the Senate bill.
House bill
Senate bill
40 years old
$75,000 income
Higher-income Americans get subsidies under the House bill, but not the Senate bill.
Both Senate and House bills drastically increase costs for older Americans
Both bills include changes that would mean older people pay more and younger people pay less — making both groups’ premiums more reflective of their actual health-care costs. The bills allow insurers to charge older people five times more than younger people (as opposed to three times under the ACA).
On top of that, both bills cut older Americans’ subsidies, in many places by more than two-thirds. The House’s cuts are generally steeper.
HOW MUCH PEOPLE WOULD PAY FOR
ANNUAL PREMIUMS, COMPARED TO
THE ACA
PAY MORE BY:
$3,000
$2,000
$1,000
PAY LESS BY:
No change
$1,000
No data
HOW MUCH PEOPLE WOULD PAY FOR ANNUAL PREMIUMS, COMPARED TO THE ACA
PAY MORE BY:
PAY LESS BY:
$3,000
$2,000
$1,000
No change
$1,000
No data
60 years old, $20,000 income
House bill
Senate bill
In New York, Minnesota and Alaska, people making $20,000 could remain on public insurance.
60 years old, $40,000 income
House bill
Senate bill
Low-income elderly people would pay around $4,000 more under the Senate bill than they do today. But under the House bill, they’d pay $8,000 more.
In New York, Minnesota and Alaska, people making $20,000 could remain on public insurance.
House bill
Senate bill
60 years old
$20,000 income
60 years old
$40,000 income
Low-income elderly people would pay around $4,000 more under the Senate bill than they do today. But under the House bill, they’d pay $8,000 more.
House bill
Senate bill
60 years old
$20,000 income
In New York, Minnesota and Alaska, people making $20,000 could remain on public insurance.
60 years old
$40,000 income
Low-income elderly people would pay around $4,000 more under the Senate bill than they do today. But under the House bill, they’d pay $8,000 more.
Under these bills, younger people’s costs would tend to go down. Because insurers would have more leeway to increase charges for older people, younger people’s premiums tend to drop.
In the Senate bill, younger people’s subsidies tend to decrease, but by less than their premiums decrease. In the House bill, many younger people’s premiums actually rise.
27 years old, $40,000 income
House bill
Senate bill
Prices would drop for middle-income young people nationwide, about twice as much under the House bill than under the Senate bill.
House bill
Senate bill
27 years old
$40,000 income
Prices would drop for middle-income young people nationwide, about twice as much under the House bill than under the Senate bill.
House bill
Senate bill
27 years old
$40,000 income
Prices would drop for middle-income young people nationwide, about twice as much under the House bill than under the Senate bill.
Senate bill cuts rural subsidies less than House bill
Health-care costs, and therefore insurance premiums, vary widely across the country, with rural areas tending to be more expensive. By basing subsidies in part on geography and generally providing greater subsidies for people living in rural areas, the ACA and the Senate bill keep premiums as affordable in more expensive areas as they are in cheaper locations.
In contrast, the House bill gives a flat subsidy to everyone of the same age, so people in more expensive areas, such as Alaska, end up having to pay a lot more than people in cheaper areas, such as in the Northeast.
HOW MUCH PEOPLE WOULD PAY FOR
ANNUAL PREMIUMS, COMPARED TO
THE ACA
PAY MORE BY:
$3,000
$2,000
$1,000
PAY LESS BY:
No change
$1,000
No data
HOW MUCH PEOPLE WOULD PAY FOR ANNUAL PREMIUMS, COMPARED TO THE ACA
PAY MORE BY:
PAY LESS BY:
$3,000
$2,000
$1,000
No change
$1,000
No data
27 years old, $30,000 income
House bill
Senate bill
40 years old, $30,000 income
House bill
Senate bill
The Senate bill raises low-income Alaskans’ premiums by around $4,000. The House raises them by about $15,000, but up to $33,000 in some areas.
House bill
Senate bill
27 years old
$30,000 income
40 years old
$30,000 income
The Senate bill raises low-income Alaskans’ premiums by around $4,000. The House raises them by about $15,000, but up to $33,000 in some areas.
House bill
Senate bill
27 years old
$30,000 income
The Senate bill raises low-income Alaskans’ premiums by around $4,000. The House raises them by about $15,000, but up to $33,000 in some areas.
40 years old
$30,000 income
In the next week, it should become more clear whether the Senate’s bill can pass. Republicans will need almost all of their members to support it, but many Senators have already expressed concern or opposition. A vote is expected on Thursday and if it passes, it will have to be reconciled with the House’s more conservative bill before heading to President Trump’s desk.
Darla Cameron contributed to this report.
About this story
Net premium data from the Kaiser Family Foundation. The maps assume that states do not waive essential health benefits or community rating.
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