The United States spends more per capita on health than any other member of the OECD, according to its June 2016 statistics, and yet the system fails in many key areas. Maternal healthcare is worse than in Iran, Turkey and Libya, according to a 2015 report to the WHO. Patients are faced with byzantine bureaucracy and billing structures.
President Donald Trump was elected on a promise to “repeal and replace” Obamacare, Barack Obama’s flagship healthcare program, which was designed to revolutionize how Americans received medical support.
Mr Trump signed an executive order to begin unpicking Mr Obama’s scheme on the day of his inauguration: on March 6, the Republicans finally published their plan.
Paul Ryan, speaker of the house, says that Obamacare has failed America. Insurance premiums have risen by double digits in 31 states. Choice of insurer has fallen; one in three counties has just one insurance provider offering coverage.
But supporters of Obamacare point out that it has provided health coverage to 21 million Americans, who were previously uninsured. They say Mr Trump’s plan will risk the lives of America’s poorest.
Obamacare is officially known as the Affordable Care Act.
Trumpcare’s real name is the American Health Care Act.
Neither president sought to name the plan after themselves; both presidents, unsurprisingly, have seen the proposals colloquially known after them.
1. Tax credits to help buy insurance
Republican supporters say Trumpcare uses the market, rather than government control, to provide healthcare.
Refundable tax credits, based on a person’s age and income, will be introduced to help a person buy insurance, if they don’t have it through their job. People under 30 get $2,000 a year; over 60s can claim $4,000. Critics point out that this could mean the inland revenue will be writing cheques to pay people who do not pay that amount in tax.
The wealthiest sectors of society will not be eligible for tax credits.
2. No more limits on healthcare savings
Americans will now be able to nearly double the amount of money that they can save in a healthcare savings account: Obamacare placed limits on it. Americans will no longer be forced to have insurance, and larger employers will no longer be forced to insure their workers:
3. No more fines for the uninsured
Obamacare included fines for individuals who did not have insurance, and forced large companies to provide cover. Under Trumpcare, fines are removed – but insurance companies can charge a 30 per cent premium if cover is allowed to lapse for 63 days or more.
4. Insurance companies now set their own prices
Insurance companies will have more freedom to set their own prices: it means that older people could pay five times the amount charged by younger consumers. Obamacare set the limit at three times the price.
The expansion of Medicaid – a programme which uses federal and state funds to support insurance for the most needy, such as disabled people and those deep in poverty – will be gradually rolled back.
5. Cuts to women’s healthcare
Planned Parenthood, which receives federal funding to provide women’s healthcare – abortions, contraception and cancer screenings – will see its funding cut.
Hospitals fear they too will suffer: Obamacare reduced the amount they had to write off from uninsured patients, with unpaid bills.
What remains the same?
Young adults under the age of 26 will still be able to be covered by their parents’ plan.
People with previously diagnosed medical conditions cannot be denied insurance coverage.
All insurance companies must offer 10 essential health benefits, including maternity care and preventative services.
Insurance companies are also barred from setting a limit on how much they have to pay to cover someone.
How much will it cost?
There’s the rub. We don’t know. No figures have been given.
Republicans were enraged by Mr Obama’s perceived lack of transparency in implementing Obamacare, but, unsurprisingly, are quite happy to go along with their own party’s scant information.
Who opposes it?
The Democrats, of course. But many Republicans, too.
The House Freedom Caucus – a group of around 30 hard-liners – is leading the protests. Rand Paul, the libertarian senator from Kentucky, is another high profile opponent.
Conservative think tanks and associations including the Heritage Foundation, Club for Growth, Freedom Partners and Americans for Prosperity, a group run by the powerful Koch brothers, also opposed the plan.
AARP, a group which campaigns for older Americans, also came out against the proposal.
This poses a problem: Republicans can only afford to lose two Republican votes in the Senate, and 22 in the House – assuming all Democrats vote against it.
What happens next?
On Wednesday two Republican-controlled committees – the energy and commerce, and the ways and means – considered the bill for a “mark-up session”.
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