Amidst all the talk in Congress of repealing and replacing the Patient Protection and Affordable Care Act (ACA) (P.L. 111-148), the Kaiser Family Foundation has provided information on its website allowing visitors to perform side-by-side comparisons of the ACA and replacement plans proffered by Congress, including House Speaker Paul Ryan’s (R-Wis) A Better Way plan; the Empowering Patients First Act, proposed by HHS Secretary Tom Price during his tenure as a Republican representative from the state of Georgia; Sen. Bill Cassidy’s (R-La) Patient Freedom Act; and Sen. Rand Paul’s (R-Ky) Obamacare Replacement Act.
The House Committee on Ways and Means continues to tout A Better Way as the answer to issues created by the ACA; Secretary Price’s proposal differs even more profoundly than Ryan’s plan from the ACA with respect to certain provisions. Both proposals would eliminate the ACA’s individual and employer mandates. Both plans would repeal cost-sharing subsidies and would implement refundable, flat-rate, age-adjusted tax credits in lieu of the ACA’s income-dependent tax credits. Price’s plan, however, would completely repeal the requirement that individual and group policies permit children to remain on their parents’ plans up to age 26 and would also repeal Medicaid expansion.
Price’s plan would repeal the wholesale prohibition against exclusions for pre-existing conditions; instead, it would prohibit such exclusions for people with at least 18 months of continuous prior coverage, but would permit exclusion periods up to 18 months for people with less than 18 months of continuous prior coverage, provided those periods are reduced by prior continuous coverage. Paul’s plan is unique in its proposal to restore pre-ACA portability protections under the Health Insurance Portability and Accountability Act (HIPAA) (P.L. 104-191) which required non-group insurers to offer policies with no pre-existing condition exclusion periods to eligible individuals leaving group health plans who maintained at least 18 months of continuous coverage.
Notably, Cassidy’s plan would allow states the option to impose Title I of the ACA, and then impose different requirements on ACA electing states compared to patient-grant electing states.
Detailed information on all of the proposals, including positions on market rules, benefit design, health savings accounts, high-risk pools, selling insurance across state lines, Medicare, financing, and other issues, are available at KFF.
Companies: Kaiser Family Foundation
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