Who gets care and who does not and what they pay for it is what this is all about. But it is a matter of degree— neither party has a plan to truly insure everyone and different people pay more or pay less. The fist two Republican bills cut coverage to millions and used the savings to pay for huge tax cuts to the super rich. But this newest bill did not cut taxes (unless that is to come in tax reform) but made big cuts to programs and gave the money saved to block grants to the states to create their own programs — and increase their own taxes where the small block grants will not be enough.  Some of the problem of who gets and pays what would be the States’ and who knows what that will be like. But in my opinion would be kicked back to Congress again in the near future by insurance companies and politicians.