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GOP False Promises Primer: How Affordable Care Act Replacement Proposals Fall Short

JANUARY 26, 2017

Download a printable PDF of this primer here.

GOP ProposalWhat it doesWhat they’ll sayHow it falls shortHow it differs from ACA
Creating state high-risk poolsCreates special state-based plans for people with serious pre-existing conditionsLowers premiums for everyone else while still providing access to insurance for sicker people

Leaves states unable to cover their costs — eventually premiums rise to unaffordable levels, states must scale back benefits or cap enrollment

The scant federal support Republicans have promised means a repeat of these problems 

ACA bans discrimination against people with pre-existing conditions

ACA keeps healthy people in the pool — and premiums down — through the individual mandate and sufficient premium subsidies

Expanding Health Savings Accounts (HSAs)Increases the amount individuals can deposit into tax-favored HSAs and/or allows HSA funds to be used for premiumsAllows for consumer-directed care as patients control where their money goes — which helps keep costs downBenefits go disproportionately to the wealthy — as the accounts give a bigger tax break to those in higher tax brackets — while lower- and middle-income families most likely to be uninsured receive little helpACA provides tax credits for working families and expands Medicaid to those who struggle most to afford insurance
Allowing insurers to sell across state linesAllows insurers licensed in one state to sell insurance to individuals in another stateIncreases competition among insurers and options for consumers

Allows plans from weakly regulated states to attract healthier individuals

Leaves a sicker pool of people in states with stronger rules, and leave consumers without protection if they have problems with their insurer Drives up premiums for older and sicker people

ACA protects state authority over their markets

ACA promotes insurer competition by creating a level playing field

ACA discourages insurers from competing only by avoiding people who have health conditions

Protecting people with pre-existing health conditions only if they have continuous coverageGuarantees access to an individual-market plan, regardless of pre-existing conditions, but only if people have maintained coverage without a gapEnsures that people who have been “responsible” can get coverage even if they have health problems

Rolls back popular protections by leaving people who have a gap in coverage facing much higher premiums or being denied coverage outright.

Hits people with pre-existing conditions, lower incomes, and without employer coverage hardest

ACA ensures access to affordable coverage for a broad array of people It prods healthier people with the mandate to buy coverage

It won’t punish people facing hard times

Establishing new tax credits for health coverageReplaces ACA tax credits with fixed amounts that don’t change based on income, plan cost, or adequately adjust for ageGives consumers more power and choice, and keeps costs down because people have more “skin in the game”

Reduces people’s ability to afford comprehensive coverage

Hits lower- and moderate-income families hardest, who are most likely to be uninsured

ACA credits automatically adjust based on income, age, and the cost of a good plan to help people most likely to struggle to pay premiums. ACA also helps with deductibles and co-pays for the low-income.
Restructuring Medicaid through block-grants /per-capita capsRestructure Medicaid financing by capping and cutting federal fundingProvides flexibility to states to revamp their Medicaid programs so that they can find the most cost-efficient way to provide care

Imposes deep cuts to federal Medicaid funding for states, leading them to impede enrollment, cut eligibility, and reduce benefits and provider payments

Eliminates or reduces access to care and coverage for millions of low-income families, people with disabilities, and seniors

ACA expanded Medicaid to provide greater access to insurance for low-income people

Medicaid offers states flexibility to reform care delivery, improve health outcomes, lower costs