What's in the latest version of the GOP health care bill

The American Health Care Act has been through a number of iterations since it was first introduced earlier this month after it garnered criticism from both conservative and moderate Republicans.

The original version of the bill, offered on March 6, included a system of tax credits for healthcare, got rid of the individual mandate under Obamacare, but kept a list of benefits that had to be included in every plan, prohibiting insurers from barring those with pre-existing conditions and allowed youth to stay on their parents' plans until they are 26.

The nonpartisan Congressional Budget office said that the plan would mean that some 24 million more people would be uninsured in a decade compared to the current law, the Affordable Care Act.

The bill -- which was pulled from consideration Friday afternoon when Republicans realized they did not have enough votes -- has since been amended, dropping the list of mandated benefits and deferring to the states, increasing health savings accounts and allowing states to institute a work requirement for Medicaid.

Here's a look at some of what is inside the Republican-backed health care bill:

Ends individual mandate, imposes surcharge for coverage lapse

The American Health Care Act would rescind the federal mandate that all Americans have health insurance or pay a penalty on their taxes. This would allow people to choose not to purchase coverage if they so desire; the CBO projects thousands of Americans will make that choice.

One possible consequence of ending the mandate is higher prices and premiums for others. To incentivize coverage, the bill would allow insurers to increase premiums by 30 percent for anyone seeking an insurance policy after going a period without it.

Ends Obamacare premium subsidies, offers tax credits instead

The House GOP bill would provide tax credits between $2,000 and $14,000 per year for individuals who don’t receive insurance coverage from an employer or the government. The credits would be based on age instead of income, but capped for higher income earners. The impact could be staggering, especially for the poor and elderly.

A 64-year-old who makes $26,500 a year could see their net out-of-pocket costs increase from $1,700 a year under the current law to $14,600 a year under the GOP plan, according to Congressional Budget Office estimates. A 40-year-old making the same amount would pay a few hundred dollars more after the tax credits, from $1,700 under Obamacare to $2,400 under the GOP bill.

The independent Kaiser Family Foundation estimates that the tax credit structure may lead to lower premiums in some cases but that plan deductibles will go up -- which, in turn, means higher overall out-of-pocket costs for many consumers who get sick.

Last minute changes to the bill that allow higher-income earners to take a larger tax deduction and released an additional $90 billion for Senate to use to potentially change the tax credit structure, according to CBO.

Ends federal ‘essential health benefits’ requirement

Insurance companies would no longer be required by the federal government to cover a list of 10 “essential” services in every health plan they offer. Under current law, mental health and substance abuse services, prescription drugs, preventive care, maternity care, emergency services and lab services are all deemed “essential” and must be included in every plan.

Rescinding this provision would result in lower premiums for some, according to the Kaiser Family Foundation, but “with no benefit requirements, insurance policies could get quite skimpy,” Kaiser analyst Larry Levitt wrote on Twitter.

With no benefit requirements, insurance policies could get quite skimpy. No insurer wants to be the one most attractive to sick people.

— Larry Levitt (@larry_levitt) March 22, 2017

“Without a requirement to cover essential benefits, the most likely benefits to go are: Mental health, Substance use, Maternity, Expensive drugs,” he added. “With no required benefits, some (like mental health or maternity) would be very expensive because only people who need them would buy them,” Levitt wrote.

Without a requirement to cover essential benefits, the most likely benefits to go are:
Mental health
Substance use
Expensive drugs

— Larry Levitt (@larry_levitt) March 24, 2017

The GOP bill would instead require states to determine what constitutes "essential benefits" in plans, starting in 2018, meaning there would no longer be a national mandate. On Thursday night, lawmakers added $15 billion for states to help cover gap in mental health and maternity coverage.

Rolls back Medicaid expansion across 30 states

The Republican plan would raise the bar for Medicaid eligibility among lower-income Americans and cap federal payments to states for the program through block grants. The changes would reduce federal spending on Medicaid by $880 billion over the next decade, pushing more of the financial burden for covering more than 74 million people in the program onto the states, according to the Kaiser Family Foundation. The CBO estimates that 14 million fewer people would be covered by Medicaid by 2026.

The GOP bill also says that Medicaid plans in the next few years will not have to cover these essential health benefits. States will get to decide what those plans have to cover.

Andy Slavitt, former acting administrator of the Centers for Medicare and Medicaid Services under President Obama, told ABC News that there are real consequences for the women on these plans. “Once something is not required, it becomes difficult for one company to offer it.”

“It can be a tough business decision," Slavitt said in a phone interview this week. "The fear is that you may attract only sicker folks. It can be a race to the bottom in terms of what’s offered.”

Allows states to impose Medicaid work requirement

The American Health Care Act as it stands would also expressly allow states to require “able-bodied” adults on Medicaid to show proof of work to get coverage. This will likely lead to more people being kicked off, some experts say.

Dr. Richard Frank, former deputy assistant secretary for planning and evaluation at HHS under President Obama, told ABC he thought work requirements would largely impact the mentally-ill people or those struggling with addiction, who make up about 30 percent of the people who could fall under the requirement.

“If you take away their coverage, because of that you are going to reduce their chance of working, rather than if you cover them and get them treatment,” he said.

Expands health savings accounts

The Republican plan would significantly expand the amount of money people can put into a tax-free account for spending on health and medical costs. The current cap of $3,400 per year for an individual would rise to $6,550 starting in 2018. For families, the limit would increase from $6,750 to $13,100.

Changes rule for pricing health plans by age

Under the GOP plan, insurers will be allowed to charge older Americans more based on their age. Current law only allows insurance companies to charge older Americans three times the cost of the prices charged to younger Americans. The new law would raise the ratio limit to five times. States would also be allowed to set their own ratio.

Repeals consumer taxes

The bill would repeal a list of taxes imposed by the Affordable Care Act, including a tax on certain health insurance plans; tax on some brand-name prescription medications; tax on indoor tanning services; and a tax on the sale of certain medical devices.

Imposes abortion restriction on tax credits

The GOP plan would prohibit women from using any federal tax credits to buy a plan that covers abortion. The new legislation is consistent with the so-called “Hyde Amendment,” which prohibits taxpayer dollars from being used for abortions, except in the case of incest, rape or to save the mother’s life.

Imposes Planned Parenthood restriction for Medicaid

Under the bill, Americans on Medicaid are prohibited from receiving any reimbursement if they visit a Planned Parenthood clinic. Medicaid payments make the up the majority of the organization’s funding, although current law already stipulates that the organization cannot use any government funds for abortion procedures. Instead, the clinics treat people on Medicaid to provide contraception, screenings and other services.

Republicans argue that these Americans can visit other community health centers. Several leading abortion and contraception rights organizations claim that these centers may offer inferior care.

The latest report from the nonpartisan Congressional Budget Office estimates that approximately 15 percent of people currently on Medicaid who visit Planned Parenthood clinics would lose access to care all together, specifically those who “reside in areas without other health care clinics or medical practitioners who serve low-income populations.”

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