According to the Congressional Budget Office (CBO) and Joint Committee on Taxation (JCT), the House Republicans’ American Health Care Act would shift nearly a trillion dollars in federal funding from middle- and low-income Americans to tax breaks for high-income individuals and health care corporations, among others.
Who Loses over Ten Years
$318 Billion from Middle-Class Americans: The American Health Care Act would cut premium tax credits for working Americans by an average of nearly $1,700 and delink them from people’s income and total premium costs, reducing support for rural, older, and low-income Americans. The bill also would repeal income-based cost sharing reductions, the small business tax credit, and the shared responsibility provisions—all of which would raise costs for the middle class and reduce the number of people covered by private insurance (including employer-based plans) by 10 million by 2026.
$880 Billion from Medicaid Enrollees: By effectively ending federal funding for states that expanded coverage (starting in 2020) and imposing an inadequate growth limit on federal Medicaid spending per enrollee (including children, pregnant women, older Americans, and individuals with disabilities), the bill would shift costs to states and reduce the number of people covered by 14 million by 2026.
Who Wins over Ten Years
$355 Billion to High-Income Individuals: The American Health Care Act would repeal key taxes on high-income individuals, expand health savings accounts, and expand tax deductions. The Joint Committee on Taxation estimates that $157 billion of these tax breaks would go to millionaires.
$506 Billion to the Health Industry: The bill would reinstate a tax break for insurance company CEO pay above $500,000; eliminate taxes on health insurance companies, drug corporations, and the medical device industry; repeal Medicaid disproportionate share hospital (DSH) cuts; delay the insurance company “Cadillac tax”; and create a Patient and State Stabilization Fund, mainly designed to support insurance companies. It also would provide funding for states that may go to insurers and would remove other fees, like the requirement for large employers to offer health insurance coverage, as well as other interactions included in this number. While the associations for the insurance and drug industries have not definitively opined on the bill, the American Hospital Association, American Medical Association, American Nurses Association, and the nursing home association, among others, oppose it because it would significantly reduce coverage.