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Previewing a House GOP Leaders’ Health Plan: What Could a Plan to “Replace” Health Reform Include?

House Republican leaders claim they’ll soon announce a health plan that would both “repeal and replace” health reform (the Affordable Care Act, or ACA).  Speaker Paul Ryan has convened a task force of House committee chairs to craft a plan that House leaders hope to release by July, according to media reports — although it may not be an actual bill and the House Republican caucus may not support it.

Nevertheless, assuming we’ll see a House Republican leadership alternative to health reform, what would its key provisions likely be?  For clues, we might look at some of the common elements of other health plans from some congressional Republicans and outside analysts, though House GOP leaders to date haven’t supported such plans.

Among plans we’ve previously analyzed (here and here), the House Republican Study Committee introduced a bill in 2015 that it’s again promoting, and House Energy and Commerce Chair Fred Upton — a member of Ryan’s task force — outlined a plan last year with Senate Finance Committee Chairman Orrin Hatch and committee member Richard Burr.  In addition, conservative health policy analysts convened by the American Enterprise Institute issued a list of policy recommendations late last year.

In a series of blog posts, we’ll look at some provisions that House Republican leaders could include in their health plan:

  • Full repeal of the ACA’s coverage provisions.
  • No individual or employer mandates.
  • Tax credits or a standard tax deduction to purchase coverage in the individual market, with no additional financial help to cover the cost of deductibles and cost-sharing.
  • A return to the largely unregulated individual market that existed before the ACA.
  • Very limited or no protections for people with pre-existing health conditions.
  • High-risk pools to provide coverage to people with pre-existing conditions who would be excluded from the individual market.
  • Expansion of health savings accounts.
  • Permitting the sale of individual and small group health insurance plans across state lines.

As we’ll explain, fully repealing the ACA’s coverage provisions would eliminate the historic coverage gains since policymakers enacted health reform in 2010 as well as prevent future gains.  At the same time, the flawed, inadequate provisions of a potential House Republican leadership health plan would likely only modestly help ensure coverage for those who would be uninsured due to health reform’s repeal.  That would be particularly true for those with low incomes or pre-existing health conditions, as well as the near-elderly. 

That would likely leave many millions more people uninsured, relative to current law.  And even among those who could retain some health coverage, most would likely end up substantially underinsured and forgoing needed care compared to the coverage they’d have today.