continued Either option would limit federal responsibility, shifting that burden to the states. However, since states don't have the money to make up the difference, they would likely either reduce eligibility, curtail benefits or cut provider payments. The block grant would be more restrictive since the funding level would not adjust for increases in enrollment, which often happens in bad economic times.
The Senate bill would also shrink the program even more over time by pegging the annual growth rate of those funds to standard inflation, rather than the more generous medical inflation, starting in 2025.
The revisions to the bill would provide temporary additional funding to help states pay for home-based services for the elderly, blind and disabled and to aid states in combating public health emergencies, such as the Zika virus.
End enhanced federal funding for Medicaid expansion. The Senate would end the enhanced match rate for low-income adults covered under Medicaid expansion starting in 2021, one year later than in the House bill. It would then phase out the enhanced funding over three years, bringing federal support down to the traditional match rate starting in 2024. States, however, would have a tough time making up the difference, likely leading many to curtail enrollment, benefits or provider payments.
Allow states to institute work requirements for Medicaid. States would now have the option of requiring able-bodied Medicaid recipients to work. The disabled, elderly and pregnant women would be exempt, however.
Continue basing subsidies on income. Obamacare provides premium subsidies based on enrollees' income and cost of coverage in their area. The House bill would have offered refundable tax credits based mainly on age.
The Senate bill jettisons the House plan, instead providing assistance similar to Obamacare's subsidies. But the Senate's subsidies would be based on income, cost of coverage and age.
The Senate bill would tighten the eligibility criteria starting in 2020, shutting out more middle class folks from government help. Only those earning up to 350% of the poverty level ($41,600) would qualify, rather than the 400% threshold ($47,500) contained in Obamacare.
It would also open up the subsidies to enrollees below the poverty level so those living in states that didn't expand Medicaid could get some assistance to buy policies on the private market -- though it's questionable whether the poor could afford coverage even with the subsidies. Those eligible for Medicaid could not get the subsidies.
Peg subsidies to plans with higher deductibles. One notable change the Senate is making to the subsidy structure is to tie the payments to a less generous insurance plan. Under Obamacare, subsidy payments are based on the price of the second-lowest cost silver plan in one's area. In 2017, the average deductible for a silver plan was just under $3,600, according to Health Pocket, an insurance shopping site.
The Senate, however, would provide subsidies based on the cost of bronze plans, which had an average deductible of nearly $6,100 in 2017. This means consumers will likely have to pay more out of pocket to see the doctor and get treatment, though it reduces how much the federal government has to spend on the subsidies.