Republicans approved their plan to replace the Affordable Care Act on Thursday.

Here’s a rundown of key provisions in the American Health Care Act and what would happen if the Senate approves them and the bill becomes law.

Buying Insurance

The bill would no longer require people to buy insurance through the marketplaces created by the Affordable Care Act, also known as Obamacare, if they want to use federal tax credits to buy coverage. It also would eliminate the tax penalty for failing to have health insurance coverage, effectively eliminating that requirement altogether.

In place of that mandate, the bill encourages people to maintain coverage by prohibiting insurance companies from cutting them off or charging more for pre-existing conditions for as long as their insurance doesn’t lapse. If coverage is interrupted for more than 63 days, however, insurers can charge people a 30 percent penalty over their premium for one year.

Tax Credits

The House Republican plan would eliminate the income-based tax credits and subsidies available under the Affordable Care Act, replacing them with age-based tax credits ranging from $2,000 a year for people in their 20s to $4,000 a year for those older than 60.

That means some people will see their costs go up while others would pay less, depending on your age and where you live. This Kaiser Family Foundation interactive map shows how the change would play out across the country.

The map shows that a 27-year-old who makes $30,000 a year would see their costs rise about $2,000 in Nebraska, but fall by about the same amount in Washington. A 60-year-old however, would see costs rise almost everywhere, with increases of almost $20,000 a year in Nebraska.

Both Kaiser and the Congressional Budget Office found that on average, older people with lower incomes would be worse off under the Republican plan than under the Affordable Care Act.

Tax Cuts

The bill eliminates nearly all the taxes that were included in the Affordable Care act to pay for the subsidies that help people buy insurance. Those cuts, which add up to about $592 billion, include a tax on incomes over $200,000 (or $250,000 for a married couple); a tax on health insurers and a limit on how much insurance companies can deduct for executive pay; and a tax on medical-device manufacturers.

Medicaid

The AHCA would make dramatic changes to the Medicaid program, which is the federal –state health program for the poor and disabled.

The Affordable Care Act allows states to expand eligibility for Medicaid to single, non-disabled adults with incomes slightly above the poverty line, with the federal government picking up most of the cost. That meant single adults who earn up to $15,800 a year could qualify in the 31 states, plus the District of Columbia, that expanded Medicaid. About 10 million people enrolled under that expansion.

The Republican plan would gradually roll back that expansion starting in 2019 by cutting the federal reimbursement to states for anyone who leaves the Medicaid rolls. People often cycle in and out of the program as their income fluctuates, so the result would likely be ever-dwindling numbers covered.

The House bill also converts Medicaid from an entitlement program where the government pays all the health-related costs for those who qualify, into a grant program. The federal government would give states either a set amount of money for each Medicaid enrollee, or states can choose to receive a fixed-dollar block grant.

The Congressional Budget Office estimated in March that the bill would cut Medicaid spending by $880 billion.

Pre-Existing Conditions

The AHCA maintains protections for people with pre-existing conditions, with some important exceptions (see waivers, below). That means that someone with high medical expenses pays the same premium for the same policy as anyone else their age in their area.

State Waivers

This section of the bill essentially amounts to an optional, state-level full repeal of Obamacare. It would give states the ability to apply for a waiver that lets them opt out of most of the regulations and consumer protections that were included in the Affordable Care Act.

States could apply for waivers that allow insurance companies in their states to do three things: 1) Charge older people more than five times what they charge young people for the same policy; 2) Eliminate required coverage, called essential health benefits including maternity care, mental health and prescription drugs, required under the Affordable Care Act; and 3) Charge more or deny coverage to people who have pre-existing health conditions, such as cancer, diabetes or arthritis.

The waivers could also impact people with-employer based insurance, because they would allow insurers to offer policies that have annual and lifetime benefit limits, which are banned under the Affordable Care Act, and some companies may choose those policies for their workers to lower their premiums.

States that get waivers would likely see insurance companies offer many more policy options, some with fewer benefits and lower premiums.

Those states would be required under the law to create some other way to ensure that people with expensive illnesses are able to get health care, and the law provides up to $138 billion over 10 years for such programs, typically called high-risk pools.

However, an analysis released Thursday by the consulting form Avalere concludes that that amount would be inadequate to provide full health coverage for the number of people who now buy insurance in the individual market and have medical problems.

Overall Impact

The House approved the bill Thursday without a full analysis by the Congressional Budget Office of its costs and how many people would be covered.

The CBO report from March concluded that over 10 years, 24 million fewer people would be covered under the bill who otherwise would have had insurance under current law.

That analysis also predicted that the House bill would cut the federal deficit by $337 billion over those same 10 years.

However, changes to the bill since then would allow states to accept block grants for Medicaid; add about $38 billion for high-risk pools and maternity and childbirth care; and offer states waivers from regulations created by the Affordable Care Act. It’s unclear how much these changes would affect the original CBO score.

Source:
www.NPR.org

Who Decides the Federal Budget?
The vision of democracy is that the federal budget – and all activities of the federal government – reflects the values of a majority of Americans. Yet many people feel that the federal budget does not reflect their values and that the budgeting process is too difficult to understand, or that they can’t make a difference.
And it is a complicated process. Many forces shape the federal budget. Some of them are forces written into law – like the president’s role in drafting the budget – while other forces stem from the realities of our political system.
And while the federal budget may not currently reflect the values of a majority of Americans, the ultimate power over the U.S. government lies with the people. We have a right and responsibility to choose our elected officials by voting, and to hold them accountable for representing our priorities. The first step is to understand what’s going on.

An Evolving Process
The U.S. Constitution designates the “power of the purse” as a function of Congress.1 That includes the authority to create and collect taxes and to borrow money when needed. The Constitution does not, however, specify how Congress should exercise these powers or how the federal budget process should work. It doesn’t specify a role for the president in managing the nation’s finances, either.
As a result, the budget process has evolved over time. Over the course of the twentieth century, Congress passed key laws that shaped the budgeting process into what it is today, and formed the federal agencies – including the Office of Management and Budget, the Government Accountability Office, and the Congressional Budget Office – that provide oversight and research crucial to creating the budget.2 The process as it’s supposed to work is described here.

Before the Budget
Congress creates a new budget for our country every year. This annual congressional budget process is also called the appropriations process.
Appropriations bills specify how much money will go to different government agencies and programs. In addition to these funding bills, Congress must pass legislation that provides the federal government the legal authority to actually spend the money.3 These laws are called authorization bills, or authorizations. Authorizations often cover multiple years, so authorizing legislation does not need to pass Congress every year the way appropriations bills do. When a multi-year authorization expires, Congress often passes a reauthorization to continue the programs in question.
Authorizations also serve another purpose. There are some types of spending that are not subject to the appropriations process. Such spending is called direct or mandatory spending, and authorizations provide the legal authority for this mandatory spending.4 Federal spending for Social Security and Medicare benefits is part of mandatory spending, because according to the authorization, the government must by law pay out benefits to all eligible recipients.

How Does the Federal Government Create a Budget?
There are five key steps in the federal budget process:
1. The President submits a budget request to Congress
2. The House and Senate pass budget resolutions
3. House and Senate Appropriations subcommittees “markup” appropriations bills
4. The House and Senate vote on appropriations bills and reconcile differences
5. The President signs each appropriations bill and the budget becomes law

Step 1: The President Submits a Budget Request
The president sends a budget request to Congress each February for the coming fiscal year, which begins on Oct. 1.5
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To create his (or her) request, the President and the Office of Management and Budget solicit and accept budget requests from federal agencies, outlining what programs need more funding, what could be cut, and what new priorities each agency would like to fund.
The president’s budget request is just a proposal. Congress then passes its own appropriations bills; only after the president signs these bills (in step five) does the country have a budget for the new fiscal year.6

Step 2: The House and Senate Pass Budget Resolutions
After the president submits his or her budget request, the House Committee on the Budget and the Senate Committee on the Budget each write and vote on their own budget resolutions.7
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A budget resolution is not a binding document, but it provides a framework for Congress for making budget decisions about spending and taxes. It sets overall annual spending limits for federal agencies, but does not set specific spending amounts for particular programs. After the House and Senate pass their budget resolutions, some members from each come together in a joint conference to iron out differences between the two versions, and the resulting reconciled version is then voted on again by each chamber.

Step 3: House and Senate Subcommittees “Markup” Appropriation Bills
The Appropriations Committees in both the House and the Senate are responsible for determining the precise levels of budget authority, or allowed spending, for all discretionary programs.8
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The Appropriations Committees in both the House and Senate are broken down into smaller appropriations subcommittees. Subcommittees cover different areas of the federal government: for example, there is a subcommittee for defense spending, and another one for energy and water. Each subcommittee conducts hearings in which they pose questions to leaders of the relevant federal agencies about each agency’s requested budget.9
Based on all of this information, the chair of each subcommittee writes a first draft of the subcommittee’s appropriations bill, abiding by the spending limits set out in the budget resolution. All subcommittee members then consider, amend, and finally vote on the bill. Once it has passed the subcommittee, the bill goes to the full Appropriations Committee. The full committee reviews it, and then sends it to the full House or Senate.

Step 4: The House and Senate Vote on Appropriations Bills and Reconcile Differences
The full House and Senate then debate and vote on appropriations bills from each of the 12 subcommittees.
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After both the House and Senate pass their versions of each appropriations bill, a conference committee meets to resolve differences between the House and Senate versions. After the conference committee produces a reconciled version of the bill, the House and Senate vote again, but this time on a bill that is identical in both chambers. After passing both the House and Senate, each appropriations bill goes to the president.10

Step 5: The President Signs Each Appropriations Bill and the Budget Becomes Law
The president must sign each appropriations bill after it has passed Congress for the bill to become law. When the president has signed all 12 appropriations bills, the budget process is complete. Rarely, however, is work finished on all 12 bills by Oct. 1, the start of the new fiscal year.

Source:

“Budget Process.” National Priorities Project. N.p., n.d. Web. 27 Apr. 2017.

On March 28th, The House of Representatives passed a S.J.Res.34. This resolution overturns the rule published by the FCC, which required all Internet browsing data, as well as data regarding app usage on mobile devices, be subject to the same privacy requirements as sensitive or private personal information. It does not, however, return the power of regulating internet service providers back to the FTC.

Those who oppose this bill believe it will give internet service providers the ability to sell consumer’s personal information to third parties. Those who support it, believe it will allow ISPs the ability to be more competitive with companies that aren’t ISPs, such as Netflix.

Bill Text:

S.J.Res.34

One Hundred Fifteenth Congress

of the

United States of America

AT THE FIRST SESSION

Begun and held at the City of Washington on Tuesday,
the third day of January, two thousand and seventeen

Joint Resolution

Providing for congressional disapproval under chapter 8 of title 5,
United States Code, of the rule submitted by the Federal Communications
Commission relating to “Protecting the Privacy of Customers of
Broadband and Other Telecommunications Services”.

Resolved by the Senate and House of Representatives of the United
States of America in Congress assembled, That Congress disapproves the
rule submitted by the Federal Communications Commission relating to
“Protecting the Privacy of Customers of Broadband and Other
Telecommunications Services” (81 Fed. Reg. 87274 (December 2, 2016)),
and such rule shall have no force or effect.

Speaker of the House of Representatives.

Vice President of the United States and
President of the Senate.

References:

“S.J.Res. 34: A Joint Resolution Providing for Congressional Disapproval under Chapter 8 of Title 5, United States Code, of the Rule Submitted by the Federal Communications Commission Relating to “Protecting the Privacy of Customers of Broadband and Other Telecommunications Services”.” GovTrack.us. N.p., n.d. Web. 30 Mar. 2017.

Flake, Jeff. “Text – S.J.Res.34 – 115th Congress (2017-2018): A Joint Resolution Providing for Congressional Disapproval under Chapter 8 of Title 5, United States Code, of the Rule Submitted by the Federal Communications Commission Relating to “Protecting the Privacy of Customers of Broadband and Other Telecommunications Services”.” Congress.gov. N.p., 28 Mar. 2017. Web. 30 Mar. 2017.

Links:

https://www.govtrack.us/congress/bills/115/sjres34/summary

https://www.congress.gov/bill/115th-congress/senate-joint-resolution/34/text?format=txt

The Concurrent Resolution on the Budget for Fiscal Year 2017 directed the House Committees on Ways and Means and Energy and Commerce to develop legislation to reduce the deficit. The Congressional Budget Office and the staff of the Joint Committee on Taxation (JCT) have produced an estimate of the budgetary effects of the American Health Care Act, which combines the pieces of legislation approved by the two committees pursuant to that resolution. In consultation with the budget committees, CBO used its March 2016 baseline with adjustments for subsequently enacted legislation, which underlies the resolution, as the benchmark to measure the cost of the legislation.

Effects on the Federal Budget

CBO and JCT estimate that enacting the legislation would reduce federal deficits by $337 billion over the 2017-2026 period. That total consists of $323 billion in on-budget savings and $13 billion in off-budget savings. Outlays would be reduced by $1.2 trillion over the period, and revenues would be reduced by $0.9 trillion.
The largest savings would come from reductions in outlays for Medicaid and from the elimination of the Affordable Care Act’s (ACA’s) subsidies for nongroup health insurance. The largest costs would come from repealing many of the changes the ACA made to the Internal Revenue Code—including an increase in the Hospital Insurance payroll tax rate for high-income taxpayers, a surtax on those taxpayers’ net investment income, and annual fees imposed on health insurers—and from the establishment of a new tax credit for health insurance.
Pay-as-you-go procedures apply because enacting the legislation would affect direct spending and revenues. CBO and JCT estimate that enacting the legislation would not increase net direct spending or on-budget deficits by more than $5 billion in any of the four consecutive 10-year periods beginning in 2027.

Effects on Health Insurance Coverage

To estimate the budgetary effects, CBO and JCT projected how the legislation would change the number of people who obtain federally subsidized health insurance through Medicaid, the nongroup market, and the employment-based market, as well as many other factors.
CBO and JCT estimate that, in 2018, 14 million more people would be uninsured under the legislation than under current law. Most of that increase would stem from repealing the penalties associated with the individual mandate. Some of those people would choose not to have insurance because they chose to be covered by insurance under current law only to avoid paying the penalties, and some people would forgo insurance in response to higher premiums.
Later, following additional changes to subsidies for insurance purchased in the nongroup market and to the Medicaid program, the increase in the number of uninsured people relative to the number under current law would rise to 21 million in 2020 and then to 24 million in 2026. The reductions in insurance coverage between 2018 and 2026 would stem in large part from changes in Medicaid enrollment—because some states would discontinue their expansion of eligibility, some states that would have expanded eligibility in the future would choose not to do so, and per-enrollee spending in the program would be capped. In 2026, an estimated 52 million people would be uninsured, compared with 28 million who would lack insurance that year under current law.

Stability of the Health Insurance Market

Decisions about offering and purchasing health insurance depend on the stability of the health insurance market—that is, on having insurers participating in most areas of the country and on the likelihood of premiums’ not rising in an unsustainable spiral. The market for insurance purchased individually (that is, nongroup coverage) would be unstable, for example, if the people who wanted to buy coverage at any offered price would have average health care expenditures so high that offering the insurance would be unprofitable. In CBO and JCT’s assessment, however, the nongroup market would probably be stable in most areas under either current law or the legislation.
Under current law, most subsidized enrollees purchasing health insurance coverage in the nongroup market are largely insulated from increases in premiums because their out-of-pocket payments for premiums are based on a percentage of their income; the government pays the difference. The subsidies to purchase coverage combined with the penalties paid by uninsured people stemming from the individual mandate are anticipated to cause sufficient demand for insurance by people with low health care expenditures for the market to be stable.
Under the legislation, in the agencies’ view, key factors bringing about market stability include subsidies to purchase insurance, which would maintain sufficient demand for insurance by people with low health care expenditures, and grants to states from the Patient and State Stability Fund, which would reduce the costs to insurers of people with high health care expenditures. Even though the new tax credits would be structured differently from the current subsidies and would generally be less generous for those receiving subsidies under current law, the other changes would, in the agencies’ view, lower average premiums enough to attract a sufficient number of relatively healthy people to stabilize the market.

Effects on Premiums

The legislation would tend to increase average premiums in the nongroup market prior to 2020 and lower average premiums thereafter, relative to projections under current law. In 2018 and 2019, according to CBO and JCT’s estimates, average premiums for single policyholders in the nongroup market would be 15 percent to 20 percent higher than under current law, mainly because the individual mandate penalties would be eliminated, inducing fewer comparatively healthy people to sign up.
Starting in 2020, the increase in average premiums from repealing the individual mandate penalties would be more than offset by the combination of several factors that would decrease those premiums: grants to states from the Patient and State Stability Fund (which CBO and JCT expect to largely be used by states to limit the costs to insurers of enrollees with very high claims); the elimination of the requirement for insurers to offer plans covering certain percentages of the cost of covered benefits; and a younger mix of enrollees. By 2026, average premiums for single policyholders in the nongroup market under the legislation would be roughly 10 percent lower than under current law, CBO and JCT estimate.
Although average premiums would increase prior to 2020 and decrease starting in 2020, CBO and JCT estimate that changes in premiums relative to those under current law would differ significantly for people of different ages because of a change in age-rating rules. Under the legislation, insurers would be allowed to generally charge five times more for older enrollees than younger ones rather than three times more as under current law, substantially reducing premiums for young adults and substantially raising premiums for older people.

Uncertainty Surrounding the Estimates

The ways in which federal agencies, states, insurers, employers, individuals, doctors, hospitals, and other affected parties would respond to the changes made by the legislation are all difficult to predict, so the estimates in this report are uncertain. But CBO and JCT have endeavored to develop estimates that are in the middle of the distribution of potential outcomes.

Macroeconomic Effects

Because of the magnitude of its budgetary effects, this legislation is “major legislation,” as defined in the rules of the House of Representatives. Hence, it triggers the requirement that the cost estimate, to the greatest extent practicable, include the budgetary impact of its macroeconomic effects. However, because of the very short time available to prepare this cost estimate, quantifying and incorporating those macroeconomic effects have not been practicable.

Intergovernmental and Private-Sector Mandates

JCT and CBO have reviewed the provisions of the legislation and determined that they would impose no intergovernmental mandates as defined in the Unfunded Mandates Reform Act (UMRA).
JCT and CBO have determined that the legislation would impose private-sector mandates as defined in UMRA. On the basis of information from JCT, CBO estimates the aggregate cost of the mandates would exceed the annual threshold established in UMRA for private-sector mandates ($156 million in 2017, adjusted annually for inflation).

Reference:

“American Health Care Act.” Congressional Budget Office. N.p., 13 Mar. 2017. Web. 14 Mar. 2017.

Link: CBO Report