Q: Is the bill that passed the House today intended to repeal the Affordable Care Act?

Not entirely. In the seven years since a Democratic Congress and the Obama administration pushed through the ACA, the House has taken more than 60 votes to repeal all or part of it. But today’s vote was a first-stage effort, with the bill intended — at least originally — to address only those parts of the sprawling law with budgetary implications. It is designed that way so the Senate will have an easier time passing the legislation under a “reconciliation” process that allows bills with budgetary impact to be approved by a simple majority, rather than a filibuster-proof 60-vote majority.

Q: So what does the House Republican bill include and exclude?

In broad strokes, the legislation has a lot of financial aspects. For instance, it would substantially reduce the funding for subsidies that the ACA provides to most people seeking health coverage through insurance marketplaces the law created. It also would make other changes to those subsidies in ways that, overall, would help younger adults and increase premiums for older people. The bill also would eliminate several taxes the ACA created to help pay for its provisions, including on health insurers.

The House GOP plan would not eliminate the requirement that most Americans carry health insurance. Instead, it would get rid of the penalty imposed for not having insurance and would create a new deterrent for not having coverage: a one-year 30 percent surcharge that insurers could tack onto their rates.

Q: Would this affect the number of people with insurance in the United States?

Yes. According to an estimate of the bill’s original version by the Congressional Budget Office, 24 million more people would be uninsured by 2026. The CBO has not updated that forecast since House Republicans tinkered with aspects of the legislation to secure enough GOP votes for it to narrowly pass.

[In lieu of a CBO score, an overview of the expected effects of the GOP health-care bill]

Q: How would the bill change protections for people with preexisting conditions?

Under the ACA, insurers are prohibited from denying coverage to individuals based on preexisting medical conditions, such as cancer, depression or asthma. And the ACA requires insurers to offer “community rating,” meaning they cannot charge those with costly medical conditions more than they charge other consumers in the general insurance pool.

But an amendment written last week by Rep. Tom MacArthur (R-N.J.) would allow states to obtain a waiver from the Health and Human Services Department so they could charge customers with preexisting conditions more than other people. If HHS did not respond to a state’s waiver request within 60 days, the requested change would automatically go into effect.

Health experts predict that the result would be a sharp rise in premium increases for those with medical problems. Before the ACA became law, individuals with chronic diseases paid several times as much as others — if they could afford or be approved for a policy in the first place.

Concerned about the effect the MacArthur amendment would have on those with long-standing medical conditions, GOP Reps. Fred Upton (Mich.) and Billy Long (Mo.) crafted a provision Wednesday to provide $8 billion to help these patients pay for increased premiums and out-of-pocket costs. That money would be spread among whichever states decide to let insurers return to the practice of charging higher rates to certain customers. As part of a waiver application to HHS, a state would be required to include a “risk-sharing plan” — either recreating a so-called high-risk pool, which many states tried before the ACA — or designing a subsidy program for residents with preexisting conditions.

Q: Does the bill treat domestic violence, sexual assault, Caesarean section and postpartum depression as preexisting conditions?

The bill does not spell out either what sort of preexisting conditions insurers may take into account if states seek a waiver from the existing federal law. But in the past, some insurers had identified domestic violence, sexual assault, Caesarean section and postpartum depression as grounds for either denying coverage or charging higher premiums.

“When you can’t predict the future,” Alina Salganicoff, vice president and director of women’s health policy at the Kaiser Family Foundation, said Thursday, “one looks back to see what the prior experience has been.”

Q. What would happen to “essential health benefits”?

The ACA compels insurers to include a specific set of benefits in all health plans sold to individuals and small businesses. The House bill would change that, leaving it up to each state whether to preserve this rule or create its own set of coverage requirements — or no requirements at all. A recent Washington Post-ABC News poll found wide public support for leaving in place both this federal rule and the one regarding preexisting conditions.

Q: Would the bill affect the ACA’s requirement that all private health plans include no-cost contraception coverage?

No, but the executive order President Trump plans to issue Thursday will trigger a regulatory process to roll back this requirement. It remains unclear what sort of “regulatory relief,” as White House officials have described it, will be provided to groups that have religious objections to covering certain forms of birth control. Houses of worship are already exempt, but religious nonprofits have been required to seek an accommodation to opt out of providing free contraceptive coverage for their employees. (They can do this by either notifying their insurer, a third party administrator or the federal government of their objection, at which point the insurer must provide the coverage.)

According to a Kaiser Family Foundation survey, roughly 10 percent of large nonprofits have asked for an accommodation under the current law. “It’s not an insignificant amount of women,” Salganicoff said. She cautioned that it is difficult to predict how Health and Human Services would change the current rule and whether this accommodation provision would continue to exist if employers were given the chance to opt out entirely.

Q: Would adult children (up to age 26) still be able to remain on a parent’s health plan? 

Yes. This is one of the few facets of the Affordable Care Act that both Republicans and Democrats agree on, because it is so popular with the public.

Q: Would Medicaid be affected?

Absolutely. Republicans’ bill would cut $880 billion from the Medicaid program over the next decade, according to the most recent CBO estimate. This program provides health coverage for low-income Americans and helps pay for long-term care for people with disabilities and seniors.

Under the ACA, 11 million people have gained coverage through the ACA’s Medicaid expansion. For the next few years, the 31 states that chose to broaden their programs could keep going with that, but new people eligible under the expansion could not enroll.

Then, starting in 2020, Medicaid would switch nationwide to a very different method of federal payments, breaking with its history of paying a certain proportion for everyone enrolled and moving to a system in which each state would be given a certain amount per person — a change that critics predict would starve the program as time goes by as well as affect beneficiaries’ access to care.

Q: What are the budgetary implications of the recent changes?

The CBO has not had time to review the changes Republicans have made to the bill, so it will not be providing a budget estimate before the House votes on the measure. Before Republicans added $8 billion this week to sway lawmakers concerned about the bill’s impact on coverage for preexisting conditions, the Committee for a Responsible Federal Budget said the alterations could save up to $5 billion or cost as much as $265 billion. The uncertainty reflects a big unknown: how many states will seek waivers to change their benefits packages or the ratings rules that insurers must comply with under current federal law.

According to a CBO estimate issued in late March, the House GOP plan would cut the federal deficit by $150 billion between 2017 and 2026. It would also result in 24 million fewer Americans people being insured by 2026.

Q: How would the bill affect public health programs? 

The GOP bill would eliminate funds for fundamental public health programs, including for the prevention of bioterrorism and disease outbreaks, as well as money to provide immunizations and heart-disease screenings. It would gut something called the Prevention and Public Health Fund, which provides almost $1 billion annually to the Centers for Disease Control and Prevention. That fund accounts for about 12 percent of CDC’s total budget. If the GOP bill eventually becomes law, those public health monies would be eliminated starting in October 2018.

A significant portion of those funds, about $625 million a year, goes directly to state and local health departments. If prevention funding is lost, public health advocates warn that Americans will be at greater risk for vaccine-preventable disease, food-borne infections and deadly infections contracted in hospitals. One of the biggest recipients of the prevention fund is the CDC’s immunization program, which last year received $324 million. The money is sent directly to states and local communities to improve immunization infrastructure, such as registries that allow providers to know which patients have received what vaccines.

Q: What are the odds of the House bill passing the Senate?

Uncertain. Before the Senate could even consider it, the bill would need to pass muster with the Senate parliamentarian, who would scrutinize it to ensure it fits within the chamber’s rules on considering only matters with budgetary implications under the reconciliation process. Recent changes to the House bill — such as giving states power to decide whether to keep or jettison a set of essential health benefits that the ACA requires many health plans to include — could be an obstacle.

If and when the bill gets past the parliamentarian, many senators are wary especially of the changes the legislation would make to Medicaid.

Lena Sun contributed to this report.

Normally — a word that’s of diminishing utility in Washington — votes on major policy proposals, such as the Republican Obamacare overhaul, would be assessed by the nonpartisan Congressional Budget Office so that lawmakers have a sense of how much the bill would cost and what it would do.

In the case of the American Health Care Act, though, the most recent CBO analysis dates back to late March, the point at which Republicans gave up on trying to pass the bill the first time around. Since then, there have been several major changes to the bill in an effort to corral enough support from wavering Republicans to move it out of the House. What will the effects of those amendments be? The CBO hasn’t weighed in, but the GOP leadership is pressing forward anyway — perhaps, a cynic might suggest, because of how the CBO’s analysis of the initial effects stripped away support from members of their caucus.

So in lieu of full CBO analysis looking at how much the legislation might cost or save the government and how it would affect the number of insured Americans, we have cobbled together an independent analysis that will, hopefully, give some sense of what the bill might do.

The initial analysis

Since the policy at issue is an amended version of the original AHCA, we can start with the initial CBO analysis.

The very first iteration of the AHCA would have reduced government spending by $337 billion, mostly by cutting subsidies for those with expensive health-care plans. That savings comes despite cuts to taxes related to Obamacare.

By 2026, the net effect of the bill would be that 24 million fewer Americans would have health coverage than if the Affordable Care Act — Obamacare — were left in place. Nearly 1 in 5 Americans under the age of 65 would lack coverage by that year, compared with a bit over 1 in 10 today.

A substantial chunk of the cost savings (and reduction in coverage) is a proposed cut to Medicaid coverage of $880 billion over 10 years. That’s a reduction of about 25 percent. About half of the increase in insurance coverage under the Affordable Care Act was a function of expanded Medicaid eligibility. Incidentally, as a candidate, Trump pledged not to cut Medicaid.

The effects of the reduction in subsidies and the reduction in taxes would not be evenly distributed. Over the long term, the CBO figured that insurance premiums would drop — largely because some groups would be priced out of coverage.

Moving from scaled subsidies to a flat subsidy would mean that older and poorer Americans would have much less of their coverage subsidized, increasing the likelihood that they would let coverage lapse.

The shift that results from tax cuts and subsidy changes would increase the financial burden of those earning $50,000 a year in income or less — and benefit those earning more. Those making more than $200,000 annually would see a disproportionate gain.

The cut in taxes assessed earned the AHCA the endorsement of Americans for Tax Reform.

As Republican leaders scrambled to try to secure votes in March, they introduced several amendments aimed at increasing support. The CBO analyzed those, as well. The number of uninsured would still be 24 million higher by 2026, but the savings to the government would have dropped to $150 billion. Insurance premiums would only be slightly affected.

What the new amendments might do

After the bill was initially pulled, two amendments were introduced which have brought it back to life.

The first was an amendment backed mostly by the conservative House Freedom Caucus that, among other things, would allow states to apply for waivers to change the mandate for covering preexisting conditions — that is, medical conditions that exist before the issuance of an insurance policy and which might indicate higher long-term insurance costs. The amendment would similarly allow states to apply for waivers to define the essential benefits mandated in insurance coverage, allowing them to let insurers sell policies that are narrower in scope, potentially decreasing the cost of the policy but leaving those insured without coverage in some circumstances. This was the MacArthur amendment, named after Rep. Tom MacArthur (R-N.J.), a moderate who negotiated the plan with the Freedom Caucus.

The second was an amendment backed by Rep. Fred Upton (R-Mich.) that would add $8 billion in funding over five years to so-called high-risk pools meant to offset the higher insurance costs of covering those with preexisting conditions.

President Trump is joined by House Speaker Paul D. Ryan, congressional leadership and his family as he formally signs his Cabinet nominations into law at the Capitol on Jan. 20. (J. Scott Applewhite/AP)

It’s these changes that haven’t been assessed by the Congressional Budget Office. The Upton amendment emerged only this week, so it’s even less well explored than the MacArthur amendment but outside groups have analyzed the likely overall effects.

How many people have preexisting conditions and would therefore be at risk of increased coverage costs? (An important note: The MacArthur amendment would only allow rates to increase following a lapse in coverage.) The Kaiser Family Foundation analysis indicates that the breadth of what constitutes a “preexisting condition” — things from cancer to sleep apnea — means that 27 percent of Americans under the age of 65 fall into that category. That’s about 52 million people.

The American Medical Association released a statement on Wednesday criticizing the reliance on high-risk pools for covering those with preexisting conditions. Such pools “were not a panacea” for the 35 states that had them before the passage of Obamacare, with high deductibles, lifetime limits and big losses according to the Kaiser Family Foundation. The liberal group Center for American Progress estimates that the high-risk pools under the AHCA would be underfunded by about $20 billion annually. (Other estimates indicate a larger gap.) The Upton amendment adds $1.6 billion a year.

AARP estimates that annual costs for those with preexisting conditions could increase to $25,700 annually — relying on those high-risk pools to offset the costs. New analysis released on Thursday estimates that the funding in the AHCA would be enough to cover only 5 percent of those currently enrolled in the Obamacare exchanges who have a pre-existing condition.

News outlets have reported a number of other salient factors.

• The New York Times notes that the cuts to Medicaid spending may not only affect health coverage for low-income Americans, but also funding for special education programs in public schools. An alliance of school administrators and school psychologists has publicly opposed the AHCA.

• The Wall Street Journal reports that the effects of the AHCA’s changes wouldn’t be limited to the population that has coverage through an Obamacare insurance exchange or who are on Medicaid. Even those with coverage from their insurers could be affected, the Journal’s Stephani Armour and Michelle Hackman write.

Under the House bill, large employers could choose the benefit requirements from any state — including those that are allowed to lower their benchmarks under a waiver, health analysts said. By choosing a waiver state, employers looking to lower their costs could impose lifetime limits and eliminate the out-of-pocket cost cap from their plans under the GOP legislation.

In other words, employers will be able to pick criteria from states that reduce their costs — and reduce coverage and introduce lifetime spending caps for their employees. According to Vox, 91 million Americans had plans with lifetime spending limits before the passage of Obamacare, which removed them.

• When the MacArthur amendment was first unveiled, Vox’s Sarah Kliff found that Congress — which has coverage through the Obamacare exchanges by law — would be exempted from the effects of the amendment. That loophole still exists, though MacArthur has pledged to close it in future legislation.

Paul Markovich, chief executive of Blue Shield of California, told California Healthline that the AHCA “could return us to a time when people who were born with a birth defect or who became sick could not purchase or afford insurance.” Markovich called it a “moral imperative” to guarantee coverage. Certainly insurers would like more people to enroll in insurance plans, but it’s unusual for an insurer to want to see more costly patients sign up.

It’s important to reiterate that the long-term effects of the AHCA are uncertain. While CBO estimates aren’t perfect (they famously overestimated the increase in the number of insured people under Obamacare, for example), they’re meant to provide solid guidance for members of Congress to inform their decision-making.

In the absence of a CBO score, members of Congress are left looking at a glass of water and trying to determine if it’s half-full or half-empty. In this case, it’s not clear how much water is in the glass at all.