Republicans unveil long-sought ACA replacement

Paul Ryan holding up "A Better Way" document

At long last, House Republicans have unveiled a plan to repeal and replace the Affordable Care Act.

The plan—detailed in a document called “A Better Way”—says that “Obamacare must be fully repealed so we can start over and take a new approach.” To replace the president’s signature healthcare law, the plan weaves together a variety of healthcare policy ideas in its outline of what should replace the ACA.

Here’s a breakdown of some of the plan’s key provisions:


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A new approach to exchanges. The Republicans’ plan would offer everyone who doesn’t qualify for employer coverage, Medicare or Medicaid to access a refundable tax credit to use in the individual market—instead of the ACA’s current policy of offering tax credits to just those of certain incomes. The credit is also age-adjusted, the report says.

Association health plans,” in which small business and groups such as alumni organizations and trade associations band together to offer healthcare coverage at better rates via improved bargaining power with insurers. This would “free employers from costly state-mandated benefit packages and lower their overhead costs,” the document says.

Robust high-risk insurance pools. The plan would set aside at least $25 billion to fund programs that Republicans say would give financial support for those with high medical costs who find themselves priced out of coverage. Premiums for those participating in the high-risk pool would be capped, and wait lists would be prohibited, according to the document.

A one-time open enrollment period for the uninsured, regardless of health status. If consumers who lack coverage don’t enroll in a plan during that open enrollment period, they forfeit continuous coverage protections and could face higher insurance costs in the future.

The sale of insurance across state lines. This often-cited GOP policy proposal, according to the document, will make the insurance market more competitive and give consumers the ability to access the most affordable policies.

The preservation of certain ACA protections. The plan would prevent those with pre-existing conditions from being denied coverage, as well as allow individuals to stay on their parents’ insurance plan until age 26.

Medicaid reforms that would allow states to choose between either a per capita allotment for their programs or a block grant. States would be allowed the flexibility “to charge reasonable enforceable premiums” or offer a limited benefit package. The proposal also takes several steps to “modernize” the Medicaid demonstration waiver process, requiring them to be budget neutral while grandfathering in some successful waiver provisions.

The document, however, lacks details about how the plan would be financed. That’s because it is mainly a “framework” upon which congressional committees will build next year if the GOP maintains its majority, a senior House Republican aide told reporters Tuesday, according to Kaiser Health News.

To learn more:
- here's the report (.pdf)
- read the KHN article

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