Who wins and loses under the GOP's Obamacare repeal bill? There are several groups that stand to clearly gain — or lose.

The bill released by House Republicans doesn’t yet have an official Congressional Budget Office score or coverage estimates, so it’s hard to measure its full impact on Americans needing coverage, or health plans and providers. But there are several groups that stand to clearly gain — or lose — under the plan to repeal the Affordable Care Act.

LOSERS


— Medicaid beneficiaries — The bill would cut back funding for states to pay for the ACA’s Medicaid expansion, shifting from open-ended federal matching payments to per capita lump sum payments that would likely force governors to shrink the size of their programs. About 70 million Americans are currently covered through Medicaid, with more than 11 million gaining coverage after the ACA took effect.

“It’s not hyperbole to say this bill ends the Medicaid program as we know it,” said Aviva Aron-Dine of the Center for Budget and Policy Priorities, and the former senior counselor to former Health and Human Services Secretary Sylvia Mathews Burwell.

— Hospitals — While the bill would reinstate the disproportionate share payments that were eliminated when the ACA took effect, the planned cuts to Medicaid would likely lower hospitals’ revenues and force them to ramp up their charity care spending. Hospital profit margins are currently at their highest level since before the 2008-09 recession.

“These changes alone could result in deep funding cuts for essential hospitals, which now operate with little or no margin,” said Bruce Siegel of America’s Essential Hospitals, an advocacy group for safety-net hospitals. “Our hospitals could not sustain such reductions without scaling back services or eliminating jobs.”

— Planned Parenthood — The program would be defunded for one year under the bill, a provision that conservatives want but which risks losing the support of some moderate Republicans. The White House had reportedly offered to allow Planned Parenthood to preserve its funding if it stopped providing abortions, a deal that Planned Parenthood had rejected.

— Lottery winners — Numerous pages in the repeal bill are dedicated to ensuring that lottery winners would not be able to enroll in Medicaid coverage, an issue pushed by Rep. Fred Upton, who recently introduced standalone legislation.

WINNERS

— High-net worth individuals — The bill repeals a slew of ACA-related taxes, like a 3.8 percent investment tax on the well-to-do and a 0.9 percent surcharge on wages above $250,000. The move would save the top 0.1 percent of earners about $195,000 annually, according to the Tax Policy Center.

— The device industry — The bill would strike down the 2.3 percent medical device excise tax opposed by the industry, Republicans and some Democrats.

The tax, which took effect in 2013 before being suspended for two years in 2015, led to nearly 30,000 lost jobs, according to a report from the American Action Forum released last week.

— The tanning industry — The bill would repeal the ACA’s 10 percent excise tax on indoor tanning, which was included in the law as both a revenue raiser and a public health measure. The industry had claimed that nearly half of the nation’s tanning salons shuttered after the ACA took effect.

TBD

— Insurers — While the bill strikes down the ACA’s individual mandate, which would likely hurt enrollment, it also imposes a 30 percent surchage on consumers who fail to maintain continuous coverage.

It’s unclear what the combined impact will be for insurers. Republicans proclaim that it will create new flexibility for consumers while Democrats say it would damage the individual insurance market.

The bill “gives patients the tools they need to be in charge of their own care, like increased access to health savings accounts and tax credits to help individuals and families purchase the care they need,” said Rep. Pat Tiberi, chairman of the Ways and Means Subcommittee on Health.

“It could result in the death spiral that it purports to address,” countered Jeanne Lambrew a former top assistant to President Barack Obama for health policy now with The Century Foundation.