A side-by-side comparison of Obamacare and the GOP’s replacement plan

Here’s how the proposed Republican American Health Care Act—along with various amendments to the bill—compares to the 2010 Affordable Care Act.

Published MARCH 8, 2017

More uninsured

The latest Congressional Budget Office report casts a new shadow over the controversial legislation and probably will complicate Republican efforts to get the bill through the Senate, where it already faces difficult prospects.

An estimated 23 million people would lose insurance as a result of the version of the bill that passed the House, a decrease of 1 million compared to the first version of the bill that Republicans introduced this year. The hardest-hit in the long run would be lower-income, older and sicker Americans, according to analysis by the CBO.

Percentage of uninsured could nearly double under GOP plan by 2026
0 5 10 15 20% 2026 2020 2010 2000 1990 Pre-Affordable Care Act Pre-Affordable Care Act AHCA ACA 202618% 2010ACA signed into law 2010ACA signed into law 2010ACA signed into law 202610% Projected
Percentage of uninsured could nearly double under GOP plan by 2026
0 5 10 15 20% 2026 2020 2010 2000 1990 Pre-Affordable Care Act Pre-Affordable Care Act AHCA ACA 202618% 2010ACA signed into law 2010ACA signed into law 2010ACA signed into law 202610% Projected

Note: Chart shows the percentage of U.S. residents under 65 who lack health insurance. Data from 1990 to 2015 come from the National Center for Health Statistics; projections for 2017 to 2026 come from the Congressional Budget Office.

Medicaid

The American Health Care Act will cut $834 million in Medicaid spending, which will affect low- and moderate-income Americans. Expanded Medicaid coverage would cease and the funding structure would change.


Under the Affordable Care Act

  • The federal government and states share the cost of insuring the poor. The amount of money that Washington gives each state varies depending on how much medical care that state's Medicaid patients receive
  • The federal government is picking up almost the entire cost of expanding Medicaid coverage to low-income adults without children in the 30 states (and the District of Columbia) that have chosen to expand their programs

Under the GOP proposal

  • A fixed "per capita cap" or a "block grant" would replace the decades-old current system. Each state would have a fixed amount of money every year. That amount would increase annually by a percentage linked to the inflation rate
  • The additional federal funding that covered expanding Medicaid would be eliminated by 2020
States that adopted Medicaid expansion
AK HI MACTRINJDEMDDC WA MT CO NM AZ ND MN IA IL MI KY OH PA WV NY VT IN LA AR OR NV CA
States that adopted Medicaid expansion
AK HI MACTRINJDEMDDCWV WA MT CO NM AZ ND MN IA IL MI KY OH PA NY VT IN LA AR OR NV CA
Estimated annual change in federal Medicaid spending (in billions)
-150 -100 -50 $0 2026 2025 2024 2023 2022 2021 2020 2019 2018


Changes in insurance costs

Average premiums for health plans will be cheaper after 2020 than under Obamacare, but on average, those plans will cover less and have higher out-of-pocket expenses, the budget office projected.

Who wins and who loses under the Republican proposal depends on a few factors. In a nutshell, the new system would provide less help to low-income people and those in high-cost areas. According to a Kaiser Family Foundation study, an American who is older, has lower income and lives in an area with higher premiums like Alaska or Arizona will lose out if the Affordable Care Act, also known as Obamacare, is replaced. An American who is younger, has higher income and lives in areas with lower premiums like Massachusetts or Washington may receive additional assistance under the replacement plan.

Change in assistance between Obamacare and the Republican plan*

27 Age $20,000 $30,000 -$3,000 +$3,000 -$2,000 +$2,000 -$1,000 +$1,000 No change $40,000 $50,000 $75,000 $100,000 Annual income 40 60

Change in assistance between the ACA and Republican replacement