Senate leaders have released their Obamacare repeal bill, which would slash federal funding for healthcare and could leave millions of Americans uninsured.
Though the plan has not yet been analyzed by the Congressional Budget Office, it isn’t too different from the one passed by the House last month. The CBO projected the House bill would save the federal government $119 billion over the next decade, raise insurance deductibles and leave 23 million fewer Americans with health coverage.
Both bills would also undo several taxes on high-income Americans that are used to fund Obamacare.
The Affordable Care Act has had a huge impact on California, where roughly 4 million people have gained insurance and the percentage of uninsured residents has dropped more than half.
Below is a breakdown of some of the ways the Senate bill could affect healthcare coverage in California if it becomes law.
If you’re on Medi-Cal
Medi-Cal would arguably be the most affected. Medi-Cal, a joint program between the state and federal governments, was expanded under the Affordable Care Act in 2014.
The program has since grown to cover 13.5 million Californians, which is more than 1 out of every 3 people in the state.
For those who gained Medi-Cal coverage through the Affordable Care Act: Now anyone in California can sign up for Medi-Cal if their annual income is low enough: $16,395 or less for a single person or $22,108 or less for a couple. Medi-Cal is free for participants.
The Senate bill recommends slowly undoing the Medi-Cal expansion starting in three years, which could ultimately leave 3.9 million Californians without insurance.
It’s a move that would save the federal government roughly $13 billion annually, according to the state Legislative Analyst’s Office.
Lowell Brown, a healthcare attorney in Los Angeles, said the coverage rollback may not end up being quite as drastic, because federal legislators have said they plan to replace coverage cuts with other options.
“Will those people have some other kind of coverage, and what would it be?” Brown said. “I think that’s what everybody’s going to be looking at.”
For those who were part of Medi-Cal before Obamacare: Currently, the federal government reimburses states for Medicaid expenses, regardless of size. Critics of this funding model say it’s too open-ended and leads to out-of-control costs.
The Senate bill would cap Medicaid funding, instead giving states fixed pools of money to pay for their program. Experts say this would force California and other states to make tough decisions about how to maintain their programs. Enrollees could receive fewer benefits, take on some cost-sharing or be fully pushed out — though it’s unclear exactly how many Medi-Cal patients might be affected.
Dylan Roby, assistant professor of health services administration at the University of Maryland School of Public Health, said California has historically been generous with eligibility and benefits but less so with how much medical providers are paid.
“This will just create further pressure,” he said. “We’re going to have to juggle all of those things.”
If you have private insurance
Private health plans could also provide fewer benefits. The Affordable Care Act requires that all insurance plans include certain benefits, such as maternity care and substance abuse services, but the Senate bill allow states to opt out of that requirement. That could mean lower premiums for people who buy less generous plans.
The bill also would allow insurance companies to charge older Americans more for their healthcare than they can under the Affordable Care Act.
Through your employer: Under the bill, some employers would no longer have to provide health insurance to their employees, because the plan would effectively repeal the part of the law that mandates that large employers do so.
Through Covered California: Currently, Californians who make less than 400% of the federal poverty level receive subsidies to help pay for their insurance premiums purchased through Covered California, the state health exchange. The Senate bill would provide subsidies only for people who make up to 350% of the poverty level, or about an annual income of $42,210.
The plan would continue through 2019 a contentious part of Obamacare that pays insurance companies to reduce deductibles for low-income Americans. After that, deductibles would probably increase significantly for those consumers, experts say.
Through your parents: The Senate bill still allows people under 26 to stay on their parents’ insurance plans.
If you’re uninsured
The bill repeals the mandate requiring every American to have insurance, so people who are uninsured would no longer have to pay the annual penalty.
Though Trump tweeted that he supported the Senate bill Thursday, experts say the plan is bound to change on its way to becoming a law.
“There’s a lot more road between here and there,” Brown said.