First off, the most important thing to know about American Health Care Act (AHCA or Trumpcare) is it will almost certainly be changed in major ways by the Senate.
So there's no reason to get too worked up about this bill for now.
The second thing to know is the wild claims being made by both sides - such as healthcare costs will drop dramatically or it makes rape a pre-existing condition - are just that, wild claims that do not reflect what's actually in the bill.
Our March article How Trumpcare Will Impact Self-Employment covered the major differences between Obamacare (The Affordable Care Act) and Trumpcare. Most of what we say in that article is still true.
The quick summary from that article is:
.. self-employed who are younger or have higher incomes will likely be better off under the Republican proposed American Health Care Act (AHCA, a.k.a. Trumpcare). Self-employed who are older or have lower incomes will likely be worse off.
Poor people - and particularly older poor people - continue the big losers in this bill. Their subsidies are cut and in many cases their insurance costs will go up.
Trumpcare also substantially reduces Medicaid support for states. This will almost certainly mean state cuts in health programs that support the poor.
Older people (roughly aged 45 to 64) in general are also losers. The ACHA allows insurance companies to charge older people more than Obamacare does.
The winners are younger people and healthy people. They should see their insurance costs go down.
This is especially true if these people make too much money to qualify for Obamacare subsidies, but don't make so much they don't qualify for Trumpcare tax credits. If you make between roughly $50,000 and $150,000 you fit into this category (varies by location and filing status). The credits phase out for those making above $150,000.
But don't feel bad for the rich.
The bill eliminates two taxes on individuals earning more than $200,000 or couples earning more than $250,000: a 0.9 percent increase on the Medicare payroll tax, and a 3.8 percent tax on investment income. So they are winners too.
There's a huge outcry by opponents of Trumpcare that pre-existing conditions aren't covered in the bill. This is incorrect.
Almost everyone with pre-exiting conditions will be covered pretty much the same way they are under Obamacare.
The rules around pre-existing conditions are complicated, will likely vary by state and, yes, there are cases where having a pre-existing condition means higher insurance rates. But those cases will likely be unusual.
Those wanting to know more about pre-existing conditions under Trumpcare should read the Washington Post's Here’s what you need to know about preexisting conditions in the GOP health plan.
Also, the New York Time's Who Wins and Who Loses in the Latest G.O.P. Health Care Bill provides a nice, general summary of the bill.
The bill hasn't changed enough to change our view that the overall impact on self-employment will be modest. This is because the bill has self-employed winners and losers.
Having said that, overall we think Obamacare is better for the self-employed than Trumpcare.
The main reason is Obamacare better covers older and lower income self-employed. Self-employment is often the only or best employment choice these folks have. Because of this, they need to supported.
While we prefer Obamacare, it has problems. We think a bipartisan effort to fix these problems would be the best solution. But that's not going to happen.
On a broader philosophical level, Trumpcare versus Obamacare is a continuation of the debate between Alexander Hamilton and Thomas Jefferson over the role of the federal government.
Trumpcare is Jeffersonian in that it reduces the role of the federal government and gives more power and choice to the states and individuals.
Obamacare fits with Hamilton's Federalist views, in that it gives more power to the federal government.
The hit Broadway musical, Hamilton, nicely covers this debate - which was as fierce when our country was founded as it is today.
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