Since 2010, Republicans have attempted to dismantle or repeal the Affordable Care Act – creating uncertainty for millions of Americans that contributed to Democrats’ success in 2018.
But if Republicans wish to replace the Affordable Care Act (ACA), they’ll require a plan. And this may prove a difficult feat.
Taxes
President Donald Trump campaigned on a platform of repeal and replacement of Obamacare, and has since adopted the Republican position that this must happen. Although no specific plan has been laid out yet.
The Affordable Care Act is funded through cuts in government spending and taxes on various entities, with its main source of revenue being an individual mandate that imposes penalties on Americans without health insurance coverage. It also collects fees from medical device industry as well as raising insurance premiums through tax increases or fee increases.
Repealing these taxes would reduce spending by $43 billion between 2016-2025, according to the Congressional Budget Office. Repealing them could also lower premiums for marketplace purchasers who purchase plans ranging from bronze coverage up to platinum coverage – benefiting insurers as well as health care companies that collect these fees in the form of fees for services rendered.
Coverage
Since 2013, a small but dedicated group of reformers has advocated for turning health care into a public service, floating their plans across conservative think tanks and campaign platforms. Now they are unveiling a framework designed to protect GOP candidates against accusations they lack an alternative plan to replace Obamacare.
Their bill would repeal the individual mandate and end subsidies that reduce deductibles and other out-of-pocket costs for low income people enrolled in Affordable Care Act-compliant plans. Furthermore, it would stop Medicaid’s expansion.
No one knows exactly how the GOP plans to pay for health reform, but in order to make it affordable they would need to reduce federal spending by trillions – through revenue cuts or program eliminations – without impacting access to coverage; that will not be easy and is made even harder if their proposal cannot make the case that it is better than Obamacare.
Pre-existing conditions
It would do away with employer and individual mandates, premium subsidies on government exchanges, roll back Medicaid expansion and introduce new taxes on high-income households to fund its cost. Furthermore, it would leave individual health-insurance markets as they are today: available only to healthy individuals who can afford it themselves.
Price’s approach would eliminate many core protections of the Affordable Care Act. Under his plan, over 100 million Americans with preexisting conditions would no longer be eligible to access individual market coverage; Price suggested ways of alleviating this by creating state-run “high-risk pools” or reinsurance programs to stabilize individual markets; however, without federal funds to support such efforts coverage might become unaffordable for many with expensive illnesses, sending ripples through insurance markets and making insurers flee in fear.
Medicaid
Congress’ repeal of Obamacare would rob more than 100 million preexisting patients of essential protections, undermining Medicare and Medicaid financial sustainability while making it harder to pay for other programs, and encouraging employers to drop coverage – all which would harm middle-class families and the economy as a whole.
Republican proposals to replace Obamacare typically seek to reduce the federal government’s role in health care, often by encouraging health savings accounts or other tax-friendly tools to assist Americans pay for healthcare costs more easily. Furthermore, they discourage generous insurance plans which drive up healthcare spending further.
House Speaker Paul Ryan’s proposal aims to maintain two popular features of the 2010 health-care law: permitting young adults to remain on their parents’ plans until age 26; and prohibiting insurers from denying coverage or charging more to those with preexisting medical issues. Furthermore, his plan would delay implementation of ACA’s “Cadillac Tax” on expensive employer-provided health plans.
