House Speaker Paul Ryan Holds Weekly News Conference

Here’s how Republicans just changed their health care bill

Republicans want to repeal parts of the Affordable Care Act and fundamentally redraw health care in America. But first, they need 218 votes in the House by Thursday, when a floor vote is scheduled on the American Healthcare Act. To get them, House GOP leaders filed a package of changes to the bill Monday night.

The changes come after the Republican leadership was criticized from lawmakers on the left and right for the first version of the bill, which was released earlier this month.

So what exactly are they changing?

Big Picture

Overall, the changes take aim at three big areas.

1) increasing government help to seniors and others paying the most for health care;

2) eliminating the taxes under President Barack Obama’s Affordable Care Act faster;

3) giving states more options for Medicaid while further limiting who can sign up for the program.

To the tax credit, add more tax deduction

What it is: House GOP leaders now want to expand a tax deduction, allowing people to deduct health expenses that amount to more than 5.8 percent of their income.

What it means: Many people expected Republicans to increase tax credits for older Americans. But the tax credits have not changed. Instead, the GOP is expanding a tax deduction. Yes, this is getting complicated — but also interesting. People filing their 2016 taxes already can deduct all health care expenses over 10 percent of their income. The initial GOP bill released two weeks ago would have lowered that threshold to 7.5 percent of income. Now, in the amendment, Republicans propose that deductions start once healthcare spending is over 5.8 percent of income, a policy that would start in 2018. Meanwhile, next year, a special rule would be extended so that seniors could get the expanded deduction right away.

One note here: In their summary of the proposed changes, House GOP leaders indicated that this tweak may be meant as a pre-emptive peace offering to the Senate, where there is significant concern among Republicans that the bill will simply cost too much for seniors. The expanded tax deduction would cost roughly $85 billion, according to a House aide. The proposed spending boost was a signal that House leaders are willing to put more money on the table, and are open to Senate proposals on other ways to spend the additional funding to help cover seniors’ health care.

ACA taxes go faster

What it is: This new language would end ACA taxes in 2017, a year earlier than the previous GOP bill.

What it means: The first version of the GOP bill did not repeal all ACA taxes until 2018. This latest version proposes repealing them in 2017, meaning they would all be wiped out immediately. This is a decision by Republicans to try to gain support among conservatives, who complained that the first bill was not a fast or broad enough repeal of Obamacare. At the same time, it comes with risks. Add more tax benefits and you’ve added to the pricetag. Now everybody wants to see how (and when) the Congressional Budget Office scores this one.

Medicaid: more power for states, more limits for individuals

What it is: States would get more power. Fewer people would be automatically eligible for the program.

What it means: The biggest news here might be what Republicans did not change. They did not change the date for freezing the Medicaid expansion program under the ACA. It still closes at the end of 2019.

But the proposal out Monday does limit the number of people in the program by blocking any of the 19 states which don’t have the expansion now from signing up.

Most of all, the GOP has added more bells and whistles, in terms of flexibility, to appeal to states. That includes allowing states to choose getting their Medicaid money as a large block grant, rather than as a set amount of spending per recipient. In addition, the changes would let states add a work requirement for non-pregnant adults on Medicaid.

What we DON’T know

The bill’s shape may have changed, but the same questions remain.What will this mean for individual healthcare costs? How many Americans will be covered under this plan? And what would this do to government costs?