The Senate plan rolls back some of the gains higher-income people would see through tax credits under the House plan, while preserving one of the ACA's key protections:
- People with pre-existing conditions: The Senate plan takes out the House provision that would impose a premium surcharge on those who lapse in coverage.
- The working poor: The Senate plan fills in the gap left by Obamacare, extending tack credits for people earning less than federal poverty level ($11,700 this year) who have been shut out of the exchange market.
"Right now there are 2.6 million uninsured poor adults in states that haven't expanded Medicaid. They get nothing under the ACA," said Larry Levitt, of the Kaiser Health Foundation.
Access would start in 2020, and presumably, adults who lose Medicaid expansion coverage could also get tax credits on health plans. The question is whether they can afford to make premium payments.
Young adults: The Senate plan, like the House bill, would give insurers greater flexibility to charge younger enrollees much lower premiums and to offer skinnier plans in states that opt out of ACA's essential health benefit requirements.
HSA savers: The Senate bill boosts the tax break for people in high-deductible plans in both the individual market and employer plans, by allowing them to put enough into their health savings accounts to cover much more of their out-of-pocket costs.
"A lot of employers (now) have plans that are actually priced above the maximum HSA contribution," so people end up paying for out-of-pocket expenses with after-tax funds, said Eric Dowley, a senior vice president with Fidelity's HSA business. "This would allow them to be able to pay for those benefits on a tax-advantaged basis."
The Senate plan raises the contribution limits $100 more than the House bill. For individuals, the limit would rise to $6,650 from $3,400 currently. For families, the limit goes to $13,300 from $6,750.
The GOP plan would restore the ability to use HSA funds to pay for non-prescription health costs such as over-the-counter drugs. But some employers had hoped the Senate would have made changes when it came to drugs that treat chronic diseases.
"Preventive care is excluded from the deductible. ... Employers would love to see drugs associated with chronic conditions, like meds for diabetes or high blood pressure, excluded," said Tracy Watts, a senior partner at benefits firm Mercer.
"They're not real expensive drugs, but it's the kind of thing that you don't want the cost of them to be a barrier," for lower income workers, she said.