Two-year-old Robbie Klein of West Roxbury, Mass., has hemophilia, a medical condition that interferes with his blood's ability to clot normally. His parents, both teachers, worry that his condition could make it hard for them to get insurance to cover his expensive medications if the law changes.
If Senate Republicans vote to repeal and replace the Affordable Care Act this week, it would affect the health care of pretty much every American.
Here's a recap of four key flash points in the health overhaul debate with links to NPR coverage over the past six months, and our chart laying out how the Graham-Cassidy bill under consideration in the Senate addresses those issues compared with the Affordable Care Act.
Pre-existing conditions. One of the biggest issues in the repeal/replace debate has been coverage for pre-existing conditions,
genetic risks
and chronic illness. Before the Affordable Care Act, insurers could deny coverage to people with diseases like diabetes or charge them much higher premiums. The ACA requires insurers to cover pre-existing conditions without charging more. The GOP bills passed or proposed would give states the power to waive that requirement. People with disabilities or
chronic diseases
, people who have had
cancer,
and parents of
children born with health problems
like
late-night host Jimmy Kimmel
say that could make insurance unaffordable.
Medicaid. The federal/state insurance program provides health care for
20 percent of all Americans
, including
40 percent of children
, half of all births, 60 percent of
nursing home expenses
and 25 percent of mental health care. The Graham-Cassidy bill would transform the structure of Medicaid, giving states control over how they spend federal funds. The bill cuts Medicaid funding over time. States that expanded their Medicaid programs, including
California and New York
, would face the biggest cuts, while Texas and some states in the Deep South and West would fare better.
Essential Health Benefits. The Affordable Care Act requires that insurers cover 10 "
essential health benefits
," including maternity care, mental health, hospitalization, prescription drugs, emergency care, and children's health. The GOP proposals would let states opt out of those requirements, affecting insurance sold on the exchanges and
employer-based coverage
. But economists say that won't
lower health costs
as much as the bills' backers may hope, since the three biggest drivers of health costs are hospital care, doctor visits and prescription drugs — three things states may be most reluctant to cut.