House of Representatives Speaker Paul Ryan unveiled the new Republican healthcare agenda on June 22 that would repeal much of the Patient Protection and Affordable Care Act (ACA) (P.L. 111-148) but keep some of the health care law’s more popular provisions. Ryan’s proposal is part of his larger agenda, titled "A Better Way," to change what he considers America’s "biggest challenges."
Ryan’s plan includes proposals to:
- Expand health savings accounts;
- Offer refundable tax credits to subsidize the purchase of private health insurance and decrease dependence on employer-sponsored plans;
- Cap the tax exclusion for employer-provided health insurance;
- Allow people to purchase insurance across state lines;
- Provide $25 billion in funding for high-risk pools over 10 years;
- Devolve Medicaid to the states, either through a block grant or a per capita allotment;
- Partially privatize Medicare beginning in 2024 through a "premium support" option;
- Slowly raise the age of eligibility for Medicare to 67.
Similar goals. Some of the goals of Ryan’s plan are the same as those of the ACA. The plan proposes to ensure coverage, so that beneficiaries "never have to worry about being turned away or having your coverage taken away—regardless of age, income, medical conditions, or circumstances." Like the ACA’s so-called Cadillac tax on expensive healthcare plans offered by employers, the Republican proposal would cap the tax deductibility of employer-based plans. The plan also permits children to stay on their parents’ coverage until age 26.
Questions remain. Ryan’s proposal includes no estimate for how much the plan would cost, how generous the tax credits would be, how many people it would cover, or how many people would be forced off of Medicaid or their health exchange policies. Ryan’s proposal attempts to prevent states that haven’t already done so from expanding their Medicaid programs. Those states that already did expand under the ACA would be allowed to keep their plans.
Another Republican option. The plan was released just weeks after Representative Pete Sessions of Texas and Senator Bill Cassidy of Louisiana released a proposal that eliminates some of the ACA’s mandates but maintains the underlying structure of the ACA. This way, people who like their current plans would be able to keep them, but it would also allow people to leave the exchanges and instead receive a $2,500 tax credit (plus $1,500 for each child) to purchase health insurance on the private market or put in a health-savings account.
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