Three Republican plans that could replace the Affordable Care Act

  • House Speaker Paul Ryan Wis., center, flanked by House Ways and Means Committee Chairman Rep. Kevin Brady, R-Texas, left, and House Energy and Commerce Committee Chairman Rep. Greg Walden, R-Ore., meet with reporters on Capitol Hill in Washington, Tuesday, Feb. 14, 2017, following a GOP strategy session. (AP Photo/J. Scott Applewhite)

  • Health and Human Services Secretary Tom Price, center, accompanied by his wife, Betty, and Vice President Mike Pence, signs an official document during a swearing in ceremony, Friday, Feb. 10, 2017, in the in the Eisenhower Executive Office Building on the White House complex in Washington. (AP Photo/Andrew Harnik) Andrew Harnik

  • Sen. Susan Collins, R-Maine, followed by Sen. Kamala Harris, D-Calif., walk to the Senate chamber on Capitol Hill in Washington, Friday, Feb. 17, 2017, for the final vote to confirm Scott Pruitt to lead the Environmental Protection Agency. (AP Photo/J. Scott Applewhite) J. Scott Applewhite

Monitor staff
Published: 2/19/2017 11:34:27 PM

Uncertainty surrounds health care these days.

As Gov. Chris Sununu delivered his budget address last week, he offered few clues on the future of the state’s insurance exchanges and expanded Medicaid program. That’s largely because New Hampshire lawmakers and health officials are waiting to see what happens at the federal level.

President Donald Trump and Congressional Republicans have made clear they would like to repeal and replace the Affordable Care Act but have not yet outlined how exactly they would do so.

National reports illustrate deep internal divisions among Congressional Republicans over how to proceed – the party’s conservative wing is in favor of quick repeal, while more moderate Republicans are urging caution.

A straight repeal would suddenly leave 22 million Americans without insurance.

Here’s a breakdown of some of the plans currently being floated in Washington.

‘A Better Way’ – House Speaker Paul Ryan’s plan

This plan is seen as a more moderate replacement option. The plan requires insurance carriers to cover all patients, no matter how sick they are. But it contains a requirement making patients maintain “continuous coverage” and allows insurers to charge people more if they don’t.

Better Way would allow insurers to choose which benefits they want to cover and drop ones they don’t. This is widely seen as more advantageous for healthier people who want cheaper insurance that doesn’t cover everything, but it’s a disadvantage for sick people who can currently buy plans that cover more conditions under the Affordable Care Act.

Better Way also allows insurers to charge young people lower rates, and would allow them to charge their oldest enrollees five times as much as young ones.

To put this in dollar amounts, the nonpartisan RAND Corp. estimated premiums for a 24-year-old would decrease from $2,800 to $2,100 annually, while premiums for a 64-year-old would rise from $8,500 to $10,600.

The plan would put $25 billion toward so-called high-risk insurance pools over the next decade. These pools are designed to cover the sickest – and costliest – patients, taking them out of the overall health insurance pool and thereby lowering costs for healthier people.

When it comes to Medicaid Expansion, the plan proposes giving more control to states by providing block grants or per capita allotments and allowing states to decide how to spend it.

More conservative Republicans think Ryan’s replacement plan looks too much like the ACA.

Empowering Patients First Act – HHS Secretary Tom Price’s plan

One of the main features of this plan is fixed tax credits, which people can use to buy insurance on private markets. Each person would receive a $1,200 tax credit per year, no matter a person’s income bracket. However, that amount rises as people age; for instance, people 51 and older get $3,000 per year.

The plan also favors expanding high-deductible health savings accounts, nontaxable accounts that people can put money in for health care costs.

There are a lot of similarities between Ryan’s plan and the one proposed by Health and Human Services Secretary Tom Price a few years ago, including letting insurers drop patients if they don’t maintain “continuous coverage,” and making insurance cheaper for young and healthy people and more costly for older and sicker people.

There are also significant ways they differ. For instance, Price’s plan would do away with expanded Medicaid without a replacement option, which could end insurance coverage for more than 15 million Americans enrolled in the program.

While it would create a high-risk pool for sick patients, it would invest much less money into the pool than Ryan’s plan – $3 billion versus $25 billion over 10 years.

Under Price’s plan, insurance carriers could charge older customers as much as they want.

Patient Freedom Act – Sen. Bill Cassidy and Sen. Susan Collins’s plan

This legislation, recently proposed by Republican Sens. Susan Collins of Maine and Bill Cassidy of Louisiana, would allow states to keep the Affordable Care Act as an option.

The Patient Freedom Act would repeal the Affordable Care Act’s mandates including the individual mandate, employer mandate and benefit mandates to allow consumers to choose plans that cover fewer conditions and cost less.

It keeps prohibitions on annual and lifetime limits, bars insurance companies from refusing to cover people with pre-existing conditions and keeps a popular provision of the law that allows young adults to stay on their parents’ insurance until age 26.

The bill gives states a lot of freedom to decide how they want to proceed with setting up their health care programs. States can either re-implement the Affordable Care Act or choose a new market-based exchange where they would still receive federal dollars and tax credits that would go directly to patients’ health savings accounts.

The third option the bill outlines is for states is to design and regulate a new insurance exchange without any assistance from the federal government.

(Ella Nilsen can be reached at 369-3322, or on Twitter @ella_nilsen.)

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