House Republicans recently released their long awaited 37 page white paper entitled “A Better Way,” laying out the initial framework for their plan to repeal and replace the federal health law. The proposal lacks crucial details and almost any mention of costs and the effect it will have on the estimated 20 million people who have signed up for insurance since the start of the ACA.
The plan starts with the repeal of the ACA and its requirements and taxes, but also would likley eliminate tax credits for small businesses, bring back the Medicare donut hole, bring back cost sharing for preventive care and decrease funding for community health centers. It would then put back some of its most popular elements: Allowing young adults to stay on their parents’ health plan to age 26; banning insurers from charging people with pre-existing health problems higher premiums; and forbidding insurers from dropping coverage if a policyholder gets sick. The plan only provides protections for consumers with pre-existing conditions if they maintain continuous coverage, putting many consumers at risk for high medical costs. The Republican plan offers a compensation: high-risk pools that sell insurance only to people with very expensive medical needs. Such pools already exist, and they work extremely badly, in large part because providing insurance to people with very high medical expenses is, well, expensive
The plan also repeals all health insurance exchanges and marketplaces where consumers currently buy insurance and receive government tax credits to assist with premium costs. Instead, everyone buying policies in the individual market would receive tax credits. Older people could be charged as much as 5 times more than younger adults for insurance.
The plan would also get rid of most of the coverage requirements and the coverage expansion under the Medicaid program for the poor, so states could make them more or less generous than they are currently. It would also limit funding and states could opt for either a per-person cap or a block grant. This would likely only increase the already stark differences in coverage from state to state.
It also includes long-held Republican proposals such as allowing consumers to buy health insurance across state lines, expanding health savings accounts, reforming medical liability rules; capping medical malpractice lawsuit awards; and raising premiums for older consumers to reduce rates for younger adults.