What we know about the House GOP’s proposed replacement for the ACA

About Joanne Kenen

Joanne Kenen, (@JoanneKenen) the health editor at Politico, has been AHCJ’s topic leader on health reform and curated related material at healthjournalism.org. Follow her on Facebook.

House Speaker Paul D. Ryan (R-Wis.)

House Speaker Paul D. Ryan (R-Wis.)

The House Republicans have released an Obamacare replacement plan – though it’s sparse on details. That’s partly because the Republicans themselves don’t agree on all the specifics – and it’s partly because politically it doesn’t really behoove them to put out all the details and let Democrats shoot it down between now and November.

Most of the ideas you’ve heard before – high-risk pools ($25 billion for that over 10 years, one of the few specifics in the GOP white paper), tax credits, tax-favored health savings accounts, the ability to buy insurance across state lines (which critics say undermine consumer protections). It would also limit, to an unknown extent, the tax breaks on employer-sponsored health insurance (which a lot of policy experts across the ideological spectrum actually think is a good idea – the suspended ACA Cadillac tax went at that idea in a slightly different way.). It has some protections for people who have pre-existing conditions, as long as they are insured and maintain their coverage –although after the GOP plan scraps the employer and individual mandates, the risk pool could be sicker and insurance even more costly, or the benefits less protective.

The Paul Ryan plan also sprinkles in some other ideas favored by the GOP in recent years – introducing a “premium support” system for Medicare (though traditional Medicare would persist), raising the Medicare age from 65 to 67, some FDA reforms, and switching Medicaid to either a lump sum block grant – something that Republicans have championed for years – or a spending limit per beneficiary (the wonkier term is the per capita cap) which has been popularized partly by Louisiana Sen. Bill Cassidy. States would have a choice between the two approaches -neither of which Democrats like.

It’s obviously hard to assess the plan without a lot of details – and Republicans point out that what became the Affordable Care Act started out as white papers too. But here are some links from analysts (left, right, center-ish, and more neutral) to help you understand how to tell this story.

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