One of the major battles this year is over the repeal of Obamacare, but there has yet to be a united strategy among Republicans for exactly how to dismantle and replace the unpopular law. While no consensus strategy has yet emerged, there have been some Republican repeal plans floating around. Here are the 7 top plans to repeal and replace Obamacare.
1. Sen. Rand Paul's (R-KY) plan. Paul unveiled his plan on Jan. 25; here are the key features (h/t The Daily Caller):
- Allowing children to stay on their parents' health insurance until age 26 would remain in place.
- A two-year timeframe for those with pre-existing conditions to obtain coverage, and after that point they could get insurance "through a group market."
- Tax credits for health savings accounts (HSA) with contributions as high as $5,000.
- Independent Health Pools so people can "pool together to purchase insurance plans."
- Allowing health insurance plans to be brought across state lines.
2. Speaker of the House Paul Ryan's (R-WI) proposal. Part of Ryan's "A Better Way" agenda involved a plan to repeal and replace Obamacare that united many House Republicans in the summer of 2016. The key aspects of Ryan's plan include:
- Replace the tax incentive towards employer-sponsored insurance with refundable tax credits that consumers can use to buy healthcare and contribute to their HSAs.
- Repeal the employer and individual mandates.
- Repeal the pre-existing conditions mandate and offer high-risk insurance pools as an alternative.
- Block grant Medicaid so states have more flexibility with the program.
- Reduce state barriers to buy health insurance.
- Keep the provision allowing children to stay on their parents' plans until age 26.
- Transform Medicare into a "premium support" system, where Medicare provides subsidies for seniors to purchase private health plans.
The editors at National Review hailed the Ryan plan as a blueprint that "builds on successful reforms of the past and points us toward a more market-oriented, consumer-driven model." However, the plan received very little attention due to the fact that it was unveiled in the heat of the general election.
3. The Patient CARE Act. Co-sponsored by Sens. Orrin Hatch (R-UT) and Richard Burr and Rep. Fred Upton (R-MI). The notable parts of Obamacare being repealed includes, via Forbes:
- Medicaid is reformed by imposing a capped per-beneficiary allotment adjusted for inflation (a less stringent form of block-granting Medicaid insofar as it automatically adjusts for changes in the number of Medicaid eligibles);
- Obamacare's income-related subsidies are replaced with less expensive tax credits that vary by age, family status and income (disappearing above 300 percent of federal poverty level).
- The long-standing tax exclusion for employer-provided health insurance coverage is retained, but the ACA’s Cadillac tax is replaced by a functionally-equivalent cap on the amount of the exclusion ($12,000 for single and $30,000 for family coverage); workers in firms with fewer than 100+ workers would be allowed to purchase non-group coverage with tax credits.
However, a number of Obamacare provisions would still stand:
- May not establish lifetime limits on the dollar value of insurance benefits to beneficiaries;
- Cannot deny nor terminate coverage for medical reasons; and
- Are required to offer coverage to dependents up to age 26.
- The 3:1 age rating restrictions under the ACA are repealed and replaced only with a one-to-five maximum age rating ratio (moreover, states may elect to opt out of this requirement).
Per Forbes, the Patient CARE Act would cause premiums to be reduced across the board, particularly a six percent decrease for family catastrophic plans and 11 percent for family Bronze plans under Obamacare. It would also reduce the deficit by $534 billion in nearly 10 years but increase the number of uninsured Americans by 4 million.
4. Rep. Tom Price's (R-GA) plan. The Daily Wire has previously reported on what Price's plan would include:
- Tax credits for people to purchase private insurance.
- Increasing the availability of health savings accounts.
- Pre-existing conditions can't be denied coverage if "they had continuous insurance for 18 months prior to selecting a new policy."
- States can establish high-risk pools with federal money for those who can't afford to buy private insurance.
- Reducing the tax deduction on employer health insurance.
The knock on Price's plan is that it doesn't offer many specifics on reforming Medicare and Medicaid and in fact maintained the current spending levels for Medicare and taxes for Obamacare.
5. The Republican Study Committee plan. This plan would:
- Provide tax deductions to be used towards buying health insurance plans on the individual market.
- Provide high-risk pools for those with pre-existing conditions.
- Allow health insurance to be purchased across state lines.
6. Reps. Mark Meadows (R-NC) and Jim Jordan's (R-OH) plan. Meadows and Jordan's plan is essentially the Restoring Americans' Healthcare Freedom Reconciliation Act of 2015 that was vetoed under President Barack Obama. Here's what that plan included:
- Repeals the employer and individual mandates as well as the medical device and and excise "Cadillac" taxes, the Independent Payment Advisory Board (IPAB), Planned Parenthood funding, and automatic enrollment into Obamacare.
- Keeps the Medicaid funding levels, tax credits and some of the tax increases intact.
There is one important note about this: FreedomWorks CEO Adam Brandon issued a statement that Meadows and Jordan's recycling of the 2015 repeal plan is a means to test Republicans:
“As weak Republicans’ appetites for keeping their campaign promises to repeal ObamaCare begin to wilt, Reps. Meadows and Jordan are calling their bluff. The repeal that passed last year under a Democrat president should be the bare minimum members of Congress should pass under President Donald Trump.
“If Republicans will not even support last year’s bill now that we have a president who will likely sign it, they will send a signal to the conservative grassroots that their campaign rhetoric and promises do not matter. That would be an unacceptable and despicable result.”
7. Sens. Bill Cassidy (R-LA) and Susan Collins' (R-ME) plan. The details of their plan are as follows:
- Gives states the option of keeping Obamacare as is, receiving federal funding for their own alternative to Obamacare, or simply reform their healthcare system to their liking.
- Repeals the employer and insurance mandates and other unnecessary benefits.
- Keeps mandates for pre-existing conditions, allows children to stay on their parents' health insurance until age 26, and bans on "annual and lifetime limits.
This plan has come under scrutiny by some conservatives in Congress who are concerned that it doesn't do enough to repeal Obamacare.
(h/t: Daily Signal)
Follow Aaron Bandler on Twitter @bandlersbanter.