Republicans' ACA replacement goal: 'Universal access' to healthcare coverage

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Lowering premiums is a better incentive for individuals to get covered than the ACA’s current tax penalty for remaining uninsured, according to one top GOP aide.

As House Republicans gear up to repeal and replace the Affordable Care Act, they are leaning toward a strategy of giving individuals “universal access” to health coverage rather than mandating it.

“We would like to get to a point where we have what we call universal access, where everybody is able to access coverage to some degree or another,” a House leadership aide said Thursday, according to the New York Times.

Lowering premiums, the aide said, is a better incentive for individuals to get covered than the ACA’s current tax penalty for remaining uninsured.

Some have argued that keeping more popular provisions—like the ban on coverage denials based on preexisting conditions—while eliminating the individual mandate would send the ACA marketplaces into a “death spiral,” as insurers would be forced to hike premiums when only high-need individuals sign up for plans.

Indeed, Department of Health and Human Services Secretary Sylvia Mathews Burwell recently warned of the consequences of a partial ACA repeal, according to CNN.

"It is a difficult task and our system is one where when you move one piece, it's related to another piece," she said. "It's like a Jenga puzzle. And if you pull a piece out, you can make the thing tumble."

But Rep. Kevin Brady, R-Texas, was critical of what he called “scare tactics” about what will happen if the ACA is repealed, the Times reports. Republicans will provide an adequate transition period between a repeal and replacement of the law to ensure people don’t lose their coverage, he said.

In fact, some GOP aides are now saying that delay could last as long as four years, Politico reports. Republicans are also considering replacing the law incrementally, with small bills that address one part of the healthcare system at a time.

Leading trade group America’s Health Insurance Plans, meanwhile, is pushing for policymakers to extend the timeline for health plans to file their exchange products for the 2018 marketplace as well as fund cost-sharing reductions through 2019, in order to keep the individual marketplaces stable.