Some senators are concerned about how the Senate Republicans health care bill would affect treatment for opioid addiction.

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Two thirds of nursing home residents are paid for by Medicaid. Proposed cuts could put pressure on nursing homes and the older adults they serve.

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Republican Senators have postponed a vote on their health care bill after it appeared they did not have the votes to pass it.

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We look at the future of the Senate’s health care bill after Republican leaders postponed a vote. Also, a new ransomware attack has spread from Ukraine, and we update the fight against Boko Haram.

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Senate Republicans delayed a vote on the health care bill after it appeared they wouldn’t have the votes to pass it. Steve Inskeep talks with Matt Schlapp of the American Conservative Union.

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Since Senate Republicans released the draft of their bill to repeal and replace the Affordable Care Act last week, many people have been wondering how the proposed changes will affect their own coverage, and their family’s: Will my pre-existing condition be covered? Will my premiums go up or down?

The bill is still a work in progress, but we’ve taken a sampling of questions from All Things Considered listeners and answered them, based on what we know now.

Q: My husband and I are both in our 50s, self-employed, and we have a daughter in college. We buy insurance through the California exchange. Our family premium is now $1,100 a month with a deductible of $6,800 per person. We have never received a subsidy.

Three months ago, I was diagnosed with breast cancer. It was early stage, and I am in treatment with no cancer remaining. We are all very active and healthy otherwise.

Here is my concern: Based on what I have read, it appears our age group stands to see the biggest jump in premium costs. Not to mention, I now have a pre-existing condition. Will our premiums rise astronomically?

— Denise Estrada, Los Angeles, Calif.

A: This is a double-barreled question on premium costs and pre-existing conditions, both major concerns to consumers.

For a person in their 50s, worries about premium increases are well-founded. Under the Affordable Care Act, insurance companies are allowed to charge older people up to three times more than young people for the same insurance policies.

The Republican health care bills in both the Senate and House would allow insurers to charge up to five times more.

That change would likely lead to cheaper health plans for younger people, but also more expensive ones for those over 50. The Kaiser Family Foundation estimates that a 60-year-old in Los Angeles County who doesn’t qualify for subsidies would see her premium rise about $2,600 a year.

As for your question about your pre-existing condition, the answer would depend on where you live. The Senate bill does preserve the pre-existing condition protections that exist under the Affordable Care Act — meaning insurance companies must offer you a policy even if you have a medical problem. But it would also allow states to ask for waivers from some federal regulations, including those that define “essential health benefits.” If a state doesn’t include cancer treatment or pharmaceutical coverage in those benefits, then insurance companies can elect not to pay for some of the care you need.

Q: My 2 1/2-year-old son has been through eight hospitalizations and is fed partly through a feeding tube. We have insurance through my husband’s employer, and our son qualified for Medicaid last November because of a program in Pennsylvania for children with chronic illnesses.

The medical bills we’ve already seen would have been catastrophic without insurance, and our out-of-pocket medical expenses were thousands of dollars a year, even with insurance, before he qualified for Medicaid. His medical care needs have been so intense that I have not been able to work this past year.

We are very worried about his future care costs without Medicaid, as well as our ability to afford insurance coverage for him if pre-existing conditions are not afforded any legal protections.

How is Trumpcare likely to affect our family?

— Emily Kane, Pittsburgh, Pa.

A: It sounds like Pennsylvania’s Medicaid program has been helpful for your child. Under the proposed law, states will have even more power to design their own Medicaid programs, so there’s no reason to think that Pennsylvania would take away a local program that it has implemented.

What might be worrisome, however, are the overall reductions to the Medicaid program. The bill turns Medicaid from an open-ended program that pays for all the care beneficiaries need, to one that caps federal spending based on the number of people enrolled. The Congressional Budget Office predicts that if the Senate bill passes, Medicaid spending would be 26 percent lower, over the next decade, than it would be under the Affordable Care Act.

Some analysts believe that over time, states will have to cut services, reduce how much they pay doctors and hospitals and make it harder to qualify for Medicaid.

Q: My wife and I are both 42, and we have two children, ages 10 and 13. We have coverage through the marketplace but do not qualify for payment assistance. In addition, my wife has rheumatoid arthritis and currently uses expensive monthly injections to treat it. Would insurance still be required to cover my wife’s arthritis treatment under the new law? And how would our premiums be affected?

— Jeremy Merrill, Cedar Park, Texas

A: As far as premiums go, it looks like yours are likely to remain about the same. The Kaiser Family Foundation estimates that for a 40-year-old in Williamson County, Texas, who doesn’t qualify for subsidies, premiums are flat under the new law.

Whether your insurance will cover your wife’s condition depends largely on your governor. As I explained above, states can ask for waivers from many of the Affordable Care Act’s consumer protections, including those that define what medical services insurers have to cover.

Q: My 16-year-old daughter has Crohn’s disease. She requires Remicade infusions every six weeks. Each infusion costs $20,000. I am very concerned about lifetime maximums being reinstated. Additionally, I worry that children will no longer be able to stay on their parents’ insurance policies until 26, and that pre-existing conditions will result in higher premiums, even for employer-sponsored plans.

— Amy Lowe, Dayton, Ohio

A: You only have to worry about one of those things.

The Senate bill does include the very popular provision in the Affordable Care Act that allows children to stay on their parents’ health insurance policy until they are 26.

However, there is a chance that lifetime spending limits and annual limits [to what an insurer would pay for the care of a given patient] could return. Before the Affordable Care Act, about 60 percent of employers had lifetime limits on their health plans. The section of the bill that allows states to get waivers from federal rules opens the door to those limits making a comeback — even in employer-sponsored policies.

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Senate Republican leaders are delaying a vote on their bill to repeal and replace the Affordable Care Act, with many senators left to convince.

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NPR’s Robert Siegel talks with Drew Altman, president and CEO of the Kaiser Family Foundation, about his reactions to the health care bill proposed by Senate Republicans and why health care in America is so expensive.

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Medicaid is the government health care program for the poor.

That’s the shorthand explanation. But Medicaid is so much more than that — which is why it’s become the focal point of the battle in Washington to repeal and replace the Affordable Care Act.

President Obama expanded Medicaid under his signature health care law to cover 11 million more people, bringing the total number of people covered up to 69 million.

Now Republicans want to reverse that expansion, and they want to go much further in cutting back on the number of people covered and federal dollars spent. The legislation they’re contemplating in both the House and Senate shrinks and fundamentally restructures the program.

The report issued by the Congressional Budget Office on Monday estimates that 15 million people would lose coverage through Medicaid by 2026 under the proposed Senate bill.

Here are five key things to know about Medicaid as the debate moves forward.

Medicaid Makes Up Almost 10 Percent Of The Federal Budget

Medicaid is a joint federal/state program where both costs and regulations are divided. Today it’s an open-ended program, where the governments pay for any covered medical costs that beneficiaries need.

Federal spending on Medicaid in 2015 was about $350 billion, almost one-tenth of the $3.7 trillion federal budget. That money is supplemented by the states, so total spending on Medicaid services was $545 billion that year. Those numbers have been increasing as health costs rise and the number of people who are eligible for the program expands.

That’s what makes Medicaid a rich target for Republicans who want to put a lid on its growth. The Senate and House health plans would cap the amount Medicaid will spend per person, and then give states that amount of money to administer the program largely as they please.

Medicaid Pays For Half Of All Births In The United States

Medicaid was established in 1965 as a program to help poor single parents who were on welfare, along with their children. Two decades after that, the federal government required states to cover poor women who were pregnant for the first time. And in the early 1990s, Congress expanded coverage for pregnant women further to ensure that all pregnant women and mothers of children under age 6 with incomes up to 133 percent of poverty – or $21,599 for a family of two — are covered. According to the Kaiser Family Foundation, about half of all births are now paid for by Medicaid, ranging from 72 percent in New Mexico in 2015 to 27 percent in New Hampshire

Medicaid Pays For Most People In Nursing Homes

Medicaid pays the costs for about 62 percent of seniors who are living in nursing homes. The reason? Many seniors enter retirement with low incomes and few assets. And over time, many middle-income people who saved for retirement spend down their assets on health care.

Inpatient nursing care is some of the priciest health care out there, so even though seniors account for only 8 percent of Medicaid beneficiaries, they use 14 percent of Medicaid dollars, according to the Center for Budget and Policy Priorities.

If You Or Your Loved One Is Disabled, You May Qualify

Medicaid spends almost $200 billion a year caring for people with physical and intellectual disabilities. That’s about one-third of its budget, even though, according to the Center for Budget and Policy Priorities, only about 13 percent of those enrolled in Medicaid are disabled. The services offered to people with disabilities vary by state and can range from inpatient care to home-based services including personal care such as bathing and feeding, to school-based services for children to job coaching for adults who opt to live independently.

People Who Need Treatment For Opioid Addiction

For people who are addicted to opioids, the expansion of Medicaid has proved to be one of the only paths to treatment. The expansion, in 31 states and the District of Columbia, opened up coverage to adults without children who have incomes up to 138 percent of the federal poverty level. In 2015, the program spent nearly half a billion dollars on Suboxone, a drug used to help those addicted to opioids control their cravings and stop using. Severalstudies ahave credited the expansion of Medicaid to better access to medication-assisted treatment, which is the most successful treatment for substance abuse.

Other Adults

About 11 million people got new health coverage through the expansion of Medicaid under the Affordable Care Act. Almost two-thirds of those fall into the category of the working poor, and another 12 percent are looking for work, according to an article published by Health Affairs in March. Many low-wage jobs don’t come with health benefits, and insurance premiums are often too high for people living on the edge of poverty to buy coverage.

Under the House bill and proposed Senate bill, the people who gained coverage under Medicaid expansion would be among the first to lose insurance.

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