7 Things We Don't Know About The Republican Health Care Plan

Republicans, after seven years of pledging to repeal Obamacare, have finally released a plan to do just that. Well, sort of.

The American Health Care Act, a bill released by the House GOP and already praised by President Trump as "wonderful," leaves many of the principles of Obamacare in place, while making some adjustments.

People will receive tax credits as subsidies for health care, but they will be based on age rather than income. Insurers will still be barred from denying coverage because of preexisting conditions, and children will be able to stay on their parents' health care plans until they are 26. While there would no longer be a mandate that financially penalizes people for not buying health insurance, insurers will charge anyone who has goes for too long without coverage 30 percent above standard rates.

But while these parts of the plan are relatively clear, there are still many questions around the bill and the future of the Republicans' health care plans. Here are seven:

1. How much will it cost?

While the AHCA appears to lower the tax-based subsidies of Obamacare, it also cuts the taxes on high-income earners that paid for the subsidies. It also preserves Medicaid expansion until 2020.

But the GOP has not had the Congressional Budget Office evaluate the bill yet, so we don't know how much it will cost. By cutting taxes and preserving some of the costly part of Obamacare, the plan may end up adding to the budget deficit.

However, Congress' Joint Committee on taxation has estimated the cost to be around $600 billion over ten years.

2. How will the plan affect the uninsured rate?

According to Gallup, the uninsured rate in the United States dropped from 18 percent to 11 percent under Obamacare, which amounts to about 22 million Americans gaining insurance during that time. How many people will be insured under the Republicans' plan?

It's not clear. Again, this would be something the CBO could estimate, but it has not yet evaluated the bill. Because the plan provides younger, poorer people will fewer subsidies to provide insurance, the plan may reduce the number of these individuals who sign up for health care plans.

But a bill with this many moving parts would have very complex effects, so it's hard to say confidently what would happen without more detailed analysis.

3. What happens to Planned Parenthood?

The bill released by the Republicans withdraws funding from Planned Parenthood. This means that programs like Medicaid would not be able to cover the routine medical procedures and screenings that the clinics provide (the law already prevents federal money from covering abortions).

However, some argue that this provision will not be able to pass the Senate, because the Republicans intend to vote on the bill under "reconciliation," a procedural process that only requires 51 votes. Under reconciliation, only budgetary matters can be voted on, though, and there's disagreement about whether or not denying funds to a particular organization counts as a budgetary matter.

4. Can it pass the House and Senate?

Trump and Speaker of the House Paul Ryan have both expressed confidence that the bill will pass. This is far from guaranteed.

Representatives in the Freedom Caucus, a group of Republicans elected in the Tea Party movement, have said they oppose the plan because it is too similar to Obamacare — "Obamacare Lite" or "Obamacare 2.0," they have called it. Sen. Rand Paul, the Kentucky Republican, has also denounced the bill, calling it "dead on arrival."

The vast majority of Democrats, if not all, will almost certainly oppose the bill as well. This gives the Republicans very little room for dissention if the bill is to have any hope of passing.

5. Will it cause the market to enter a "death spiral"?

By replacing Obamacare's mandate with a surcharge on insurance for those who have gaps in coverage, the AHCA may cause healthy people to stay out of the market until they get sick, critics argue.

“You’re going to see big rate increases, and you’re going to see insurers exit markets…this is going to destabilize the marketplace,” said Dr. J. Mario Molina, chief executive of Molina Healthcare Inc., while discussing the AHCA with the Wall Street Journal.

If rates increase in the private market, more and more people could drop their coverage. Only the sickest people would keep their coverage, which would lead to even higher rates.

6. What comes next?

One of Trump's favorite policy proposals, allowing insurers to sell coverage across state lines, is not included in the AHCA. Secretary of Health and Human Services Tom Price and White House Press Secretary Sean Spicer have said that the current bill is only the first step in a multi-phase process of replacing Obamacare, and that selling coverage across state lines and other policies will come in later steps.

But what will these later phases entail? How do they affect the policies laid out in the AHCA?

We don't know yet. And it's not clear how these next steps will be implemented, since they almost certainly require Democratic votes, which may not be forthcoming.

7. What happens to Medicaid?

Expanding Medicaid to anyone earning less than 138 percent of the poverty line was a major feature of Obamacare that led to large numbers of Americans gaining coverage. Many Republicans opposed expansion, and many Republican governors blocked expansion in their own states. But AHCA preserves Medicaid expansion until 2020, at which point no new people will be able to enroll under the expanded criteria.

But also in 2020, the bill creates per capita spending caps for Medicaid. This means that, instead of covering any medical bills that Medicaid patients have, the federal government will provide fixed amounts of money per person to the states to pay for the program. Proponents argue that this plan will give states more flexibility to meet their own needs, while critics argue that it won't provide enough funds to cover the poorest Americans.

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