Poor, Elderly Stand to Be Hardest Hit Under GOP Healthcare Plan

“Generally, people who are older, lower-income, or live in high-premium areas (like Alaska and Arizona) receive larger tax credits under the ACA than they would under the American Health Care Act replacement,” the foundation found.

Kaiser only calculated the differences in tax credits and did not factor in the cost-sharing subsidies given to those with the lowest incomes. These subsidies are meant to lower deductibles and copayments for low-income enrollees in the marketplace. Last year, for example, the subsidies for those enrolled in a silver plan in the federal marketplace were $1,440 for those making between 100 percent and 150 percent of the federal poverty level, $1,068 for those at between 150 percent and 200 percent of poverty, and $144 for people with incomes between 200 percent and 250 percent of poverty.

When the loss of ACA subsidies is factored in, the Republican plan becomes even more harmful for people at the lowest incomes.

Most current healthcare.gov enrollees have lower incomes. It is estimated that about two-thirds of enrollees would be at or below 250 percent of poverty — about $31,250 for a single person in 2020 — and more than four in 10 would be earning at or below 150 percent of poverty, or $18,750.

The differences occur because while both the ACA and the AHCA include tax credits, they calculate those credits differently. Obamacare accounts for family income, age, and the local cost of insurance, while the Republican proposal bases tax credits only on age, with some reductions in credits at the highest income levels.

NJ Spotlight’s map provides options for seeing comparisons of tax credits by county for three cases: a low-income senior couple, a middle-income family and a middle-income 40-year-old. Kaiser’s map allows for many other comparisons for enrollees at age 27, 40, or 60 with an annual income of $20,000, $30,000, $40,000, $50,000, $75,000, or $100,000.

When comparing the two plans, the biggest New Jersey winners under the AHCA would be a family of four with $150,000 in income, who get no credits under the ACA and would receive $10,000 in tax credits under the AHCA and a couple of 60-year olds with $100,000 in income who would get $8,000 in credits from the Republican plan but nothing from Obamacare. The biggest losers are enrollees age 60 to 64: New Jerseyans with $20,000 in income would lose between 57 percent and 64 percent of the tax credits they get under the ACA, depending on the county where they live, while those with $30,000 in income would lose between 48 percent and 58 percent of their ACA credits.

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