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1. Many people will have to work to stay on Medicaid

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2. Less cash means less care in rural communities (and urban -Progree)

The GOP's plan would curtail a practice, known as provider taxes, that nearly every state has used for decades to increase Medicaid payments to hospitals, nursing homes and other providers and to private managed-care companies.

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3. ACA coverage will become harder to get and keep

Marketplace policyholders would be required to update their income, immigration status and other information each year, rather than be allowed to automatically reenroll — something more than 10 million people did this year. They would also have less time to enroll; the bill shortens the annual open enrollment period by about a month.

People applying for coverage outside that period — for instance, because they lose a job or other insurance or need to add a newborn or spouse to an existing policy — would have to wait for all their documents to be processed before receiving government subsidies to help pay their monthly premiums. Today, they get up to 90 days of premium help during the application process, which can take weeks.

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The legislation also does not call for an extension of more generous subsidies put in place during the COVID-19 pandemic. If Congress doesn't act, those enhanced subsidies will expire at year's end, resulting in premiums rising by an average of 75% next year, according to KFF.

4. Those on Medicaid will pay more to see the doctor
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5. Some immigrants will lose access to subsidized ACA plans
The GOP plan could cause at least hundreds of thousands of immigrants who are lawfully present — including asylum-seekers, victims of trafficking and refugees — to lose their ACA marketplace coverage by cutting off the subsidies that make premiums affordable. (Note: The restriction would not apply to green-card holders.)

Because the immigrants who would lose subsidies under this plan tend to be younger than the overall U.S. population, their exit would leave an older, sicker and costlier population of marketplace enrollees, further pushing up marketplace premiums, according to marketplace directors in California, Maryland and Massachusetts, and health analysts.

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