House Republicans Unveil Plan to Replace Affordable Care Act

Opponents decry return to “bad old days”

Six years after promising to “repeal and replace” the Patient Protection and Affordable Care Act (PPACA), House Republicans finally have a plan, according to an article posted on the Kaiser Health News website.

The 37-page white paper, titled “A Better Way,” would bring back high-risk pools for people with very high medical expenses, drop open-ended funding for the Medicaid program, and encourage small businesses to band together to gain better bargaining power in “Association Health Plans.”

The outline, however, does not indicate how much the proposed changes would cost or how they would be funded.

“It’s a framework,” a senior House Republican leadership aide told reporters, with the specifics to be determined next year by congressional committees, assuming the GOP maintains its majority. He likened the document to the white paper issued just after President Obama’s election by then-Senate Finance Committee Chairman Max Baucus, a Democrat. That document foreshadowed many of the key elements of the PPACA.

The Republican plan starts with repeal of the PPACA and its requirements and taxes, but it would then put back many of the act’s most popular features, such as allowing young adults to stay on their parents’ health plan to age 26; banning insurers from charging higher premiums for people with pre-existing health problems; and preventing insurers from dropping coverage if a policyholder becomes seriously ill.

The new plan would also repeal the current scheme of exchanges where consumers buy insurance and government tax credits to help moderate-income Americans pay their premiums if they don’t have an employer to help. Instead, everyone buying policies in the individual market would receive tax credits. Older people charged more by insurers would receive larger credits, although the outline doesn’t specify how much.

Under the plan, insurance companies could not charge higher rates to people with pre-existing conditions so long as they maintain continuous coverage, whether from an employer or in a policy they purchase themselves. The new high-risk pools would be available for those who have a break in coverage, or who fail to make a purchase during a one-time open enrollment under the plan.

The plan also would get rid of most of the coverage requirements under the Medicaid program for the poor, so states could make these requirements more or less generous than they are currently. It would also limit Medicaid funding. States could opt for either a per-person cap or a block grant to spend mostly as they wish.

With regard to Medicare, the proposal would encourage the existing movement of patients from the program’s traditional fee-for-service program to managed care plans, and would transition from the existing financing structure based on benefits to a controversial structure called “premium support,” which puts cost-controlling responsibilities more on private insurance companies. That change has been pushed by House Speaker Paul Ryan for nearly a decade.

Not surprisingly, backers of the PPACA were quick to criticize the GOP’s plan.

“Make no mistake, Ryan’s approach is not a better way forward, but a bitter path backward that returns us to the bad old days when vast swaths of Americans were left to the tender mercies of the insurance industry and could not afford needed care,” said Families USA Executive Director Ron Pollack, who pushed hard for passage of the PPACA.

“While House Republicans continue their efforts to repeal and undermine the Affordable Care Act, Democrats will work to defend the ACA so that every American has access to affordable and quality health care,” House Minority Whip Steny Hoyer (D-Maryland) announced.

Source: Kaiser Health News; June 22, 2016.