1. The Great American Health Care Debate Continues…
May 2017

2. Historic Governing Opportunity to Accomplish a Significant Agenda
2016 election consolidates control in the Republican Party
Prior times in history when House, Senate, and White House were in Republican control:
1921–1930
1953–1954
2001–2002
2003–2006

3. Health Care Coverage in the United States
Source: Boston University School of Public Health- US Healthcare: A Short Story

5. Source: Kaiser Family Foundation via FiveThirtyEight

6. Percent of Workers Offered Employer-Sponsored Coverage by Household Poverty Level, 1999-2014

7. Obamacare (ACA): Deeply Divided views by American Voters
Source: KFF.org: Kaiser Health Tracking Poll: The Public’s View on the ACA

8. The Uninsured Rate Is At An All-time Low, But The Public Doesn’t Know It

9. Current Status Of State Medicaid Expansion Decisions

10. Key Objectives of ACA Repeal/Replace
Repeal ACA tax increases
Deregulate health insurance marketplace
Expand HSAs
Reduce federal outlays by reducing federal subsidies for health insurance coverage

11. Repealing ACA Taxes: A Meaningful Opening Act for Tax Reform
Provision
Revenue Impact (2017–2026) (JCT)
Repeal 3.8% Net Investment Tax
-$158 billion
Repeal Health Insurer Tax
-$145 billion
Repeal 0.9% Additional Medicare Tax
-$117 billion
Delay Cadillac Plan Tax to 2025
-$49 billion
Repeal Increase in AGI Threshold for Medical Deduction
-$35 billion
Repeal Fee on Branded Prescription Drugs
-$25 billion
Repeal Medical Device Tax
-$20 billion
Repeal FSA Contribution Limit
-$19 billion
Repeal Other
-$8 billion
Repeal Total
-$576 billion
HSA Expansion
Total
-$595 billion

12. Average net change in federal tax and health benefits in 2022 for a family earning:
Source: “Under the Republican Health Care Plan,” New York Times, March 22, Graph from the Urban Institute’s Health Policy Center and the Urban- Brookings Tax Policy Center

13. Common Element of AHCA Reforms: Limiting federal budget exposure to rising medical costs
Premium subsidy converted to fixed tax credit
Medicaid federal share converted to per capita formula
Cadillac Tax: Delayed but not repealed

14. Changes in Insurance Subsides
Under the Affordable Care Act
People using healthcare marketplaces and making less than $48,000 a year receive subsidies to help them buy insurance
The amount of the subsidy is tied to a person's income and to the cost of insurance in the person's area

15. Changes in Insurance Subsides
Under the AHCA Proposal
People would still receive subsidies, which would phase out at incomes of $75,000 per year
The amount would be tied to a person's age, not income, so low-income people would get less help.
The subsidies would not vary with the cost of insurance, so people in high-cost areas would also not get as much help

16. AHCA Tax Credits Across Age and Income Groups

17. A Higher Uninsured Rate, Particularly Among Low-Income, Older Americans
Source: “5 Charts That Explain The CBO Report On The Republican Health Plan,” NPR, March 15, Graph from the Congressional Budget Office

20. Share Of Uninsured U.S. Residents Would Rise Under GOP Plan
Source: Congressional Budget Office via NRP.org

21. Majority Say AHCA Not Passing Is a Good Thing; But Divided on Their Reasoning

22. Health Care Spending Is Very Concentrated, With 10% Of Families Accounting For Half Of Spending

24. House Passes AHCA Along Party Lines With 20 Republican Defections
How the House voted on the AHCA
H.R. 1628: American Health Care Act of 2017
“A lot of us have been waiting seven years to cast this vote. Many of us are here because we pledged to cast this very vote.”
House Speaker Paul Ryan (R-WI)

25. Contrasting Political Pressures on Senate Republicans
50 votes required
52 Republican Senators
“Cost too much… and continues federal subsidies: “Obamacare light””
“Oppose elimination of funding for planned parenthood”
“Oppose preexisting condition provisions in AHCA”

26. -Senate Majority Leader Mitch McConnell (R-KY)
The Senate’s Turn…
"The process will not be quick, or simple, or easy…But it must be done. It is the least both parties owe to countless Americans who suffer under Obamacare and will continue to suffer if we do not act.“
-Senate Majority Leader Mitch McConnell (R-KY)