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“Universal Access”: Signs that a GOP Health Plan Will Leave Millions Uninsured

House Republicans are reportedly lowering the bar on their promise to craft a health reform replacement plan after they repeal the Affordable Care Act (ACA) early next year.  Rather than aim for universal coverage — ­insuring as many people as possible — and committing to provide coverage for those left uninsured by ACA repeal, House Republicans appear to be downgrading their goal to “universal access.”

“Our goal here is to make sure that everybody can buy coverage or find coverage if they choose to,” an anonymous House leadership aide told journalists at a health care briefing that Republican leaders organized.  “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.”

That should worry the estimated nearly 30 million people who would become newly uninsured under repeal, as the Urban Institute estimates.

Congressional Republicans have pledged to “do better” on covering the uninsured after they repeal the ACA, including eliminating its Medicaid expansion and marketplace subsidies after two or three years.  Next month, they plan to fulfill their “ironclad commitment,” the aide said, to repeal the ACA under an expedited budget process.  But they haven’t proposed a replacement plan for the millions of families that will lose coverage; the Urban Institute estimates that 4.3 million people would become uninsured in 2017.

It’s unclear what “universal access” means, but it could mean a return to the pre-ACA world.  Back then, most people could buy a health plan of some kind, but insurmountable barriers to coverage left 50 million people uninsured.  The individual market offered often bare-bones plans that were still unaffordable to many low- and moderate-income people, and some people were denied coverage due to pre-existing conditions.  Some plans had severe limits on the services and dollar amounts covered, had no limits on out-of-pocket costs a family might have to pay, and didn’t include vital benefits like prescription drugs or maternity care.

“Universal access” might merely mean the availability of a state high-risk pool, which wouldn’t cover people with pre-existing health conditions.  Either way, “universal access” apparently offers no coverage guarantee for low-income people who couldn’t afford adequate coverage before the ACA.


Director of Health Insurance and Marketplace Policy