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WASHINGTON — House Republicans released the American Health Care Act earlier this week and the legislation, which is designed to repeal and replace Obamacare, has drawn fire from both Tea Party GOPers and Democrats.

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The right-wing faction of the Republican Party in the House argues that the bill does not go far enough; Democrats say the legislation will result in millions of Americans losing access to health care.

The American Health Care Act keeps some Obamacare provisions and ditches others.

“This will be a plan where you can choose your doctor,” President Donald Trump said Tuesday. “This will be a plan where you can choose your plan. And you know what the plan is, this is the plan.”

All three members of Vermont’s congressional delegation oppose the Republican plan.

U.S. Sen. Bernie Sanders, I-Vt., says the American Health Care Act will “throw millions of people off their health insurance, make coverage more expensive for the elderly, the sick and the poor and destroy Medicaid as we know it in order to give massive tax cuts to the wealthiest Americans.

“We must fight back and work to defend and improve the Affordable Care Act, not destroy it,” Sanders said.

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The American Health Care Act does not improve the nation’s health insurance system, U.S. Sen. Patrick Leahy, D-Vt., says. It instead will “unravel the progress we have made.”

“This proposal would eliminate affordable health care access for millions of patients and their families, and it would also derail key Medicaid provisions that currently offer coverage to seniors, children, and individuals with disabilities,” Leahy said. “It would return health care decisions to big insurance companies.”

Al Gobeille, the secretary of the Vermont Agency of Human Services, which oversees state health care spending, says he’s read the bill three times and “the details are not [immediately] explainable.” That’s because the legislation does not specifically address the state and federal match for Medicaid, funding for nursing homes and health insurance subsidies for thousands of Vermonters.

“Vermont is a leader [in health care] and we don’t want to go backward,” Gobeille said. “This bill is several steps backward.”

Gobeille said he and his staff will hold a press briefing on Friday to explain how the bill will impact Vermont. “We need to make sure in this bill they don’t underfund Medicaid,” he said.

If passed in its present form, the AHCA would eliminate a mandate requiring all Americans to buy medical insurance or face a $600 annual fine. The proposed law would allow insurance companies to sell products across state lines. Funding for Planned Parenthood would be eliminated.

The American Health Care Act would continue several key provisions of Obamacare. It would prohibit health insurance companies from refusing coverage based on pre-existing conditions. It would also allow young people to stay on a parent’s plan until age 26 and would retain the state health exchanges like Vermont Health Connect.

The Republican plan penalizes people who choose not to obtain coverage differently. While Obamacare penalties were paid to the government, the Republican plan allows insurance companies to impose 30 percent surcharges on health plans for people who have been uninsured for more than two months.

The Medicaid expansion program, which has expanded health care for millions in 31 states, including Vermont, would sunset in three years. States would be allowed to continue enrolling citizens in the program until Jan. 1, 2020, at which point funding would be curbed.

The current state funding formula for Medicaid is also changed in the new health care plan. While the federal government currently funds care based on need — no matter how high costs go up — the Republican plan would instead distribute a per capita allotment to the states. Under the block grant plan, states would be given greater flexibility with federal Medicaid money, but spending would be capped.

Obamacare created income-based subsidies that took into account the local cost of insurance in every state and age. The Republican plan offers consumers tax credits instead of subsidies, which are less generous and are calculated based on age. The credits would increase based on inflation.

The Kaiser Family Foundation estimates that, under the AHCA, the average health insurance tax credit in 2020 would be at least 36 percent lower than what Obamacare would offer.

While the ACA mandated that health plans for the elderly could cost no more than three times the price of plans offered to young people, the Republican plan scraps this requirement. It sets looser restrictions, allowing insurance companies to charge elderly citizens up to five times the price of plans available to their younger cohort.

The plan would end all federal funding to Planned Parenthood and other health clinics that offer abortions, though the 1976 Hyde amendment already bans federal money from being used for abortion services.

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The plan also scraps requirements that health insurers include free preventive services like cancer screenings and contraception.

An analysis by the Kaiser Family Foundation found that older, poorer populations living in high cost health care areas would lose the most federal support under the Republican plan.

On Wednesday, the American Medical Association, which provided crucial support for the ACA, came out against the Trump-approved bill, saying it “would result in millions of Americans losing coverage and benefits.”

The AARP, which represents Americans over the age of 50, opposed the bill Tuesday in a letter from Joyce A. Rogers, a vice president for the group.

“This bill would weaken Medicare’s fiscal sustainability, dramatically increase health care costs for Americans aged 50-64 and put at risk the health care of millions of children and adults with disabilities, and poor seniors who depend on the Medicaid program for long-term services and supports and other benefits,” Rogers said.

There is not yet an official breakdown of the plan from the Congressional Budget Office, which is expected to offer a cost analysis of the plan and the number of Americans who could lose insurance.

Editor’s note: Anne Galloway contributed to this report.

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