The Republican health plan is out - and it's not pretty. Politico obtained a leaked copy of a recent plan - and here are somebasic elements.
- Eliminate the individual mandate. So if the exchanges had a "death spiral" problem from having too few healthy people before, make it worse!
- Change out income-based tax credits with much smaller age-based tax credits for all. If your health insurance costs a lot - tough luck! If you're a millionaire - congratulations - you're eligible for a subsidy.
- Swap out "guarantee issue" for a requirement of continuous coverage. If people have lost their coverage for any period of time, their health insurance costs could be sky high - or we could go back to the bad old days when they were offered coverage that excluded their preexisting illness.
- Bye bye, essential benefits. If you want to buy a health plan without maternity care - go for it! But the principles of pooling risk are left aside. Does anyone believe that affordable plans WITH maternity care will be available? They weren't before the ACA!
- Don't promise that people can afford health care. Just promise them "access." Sort of like we all have the potential for access to Mar el Lago - assuming we want to pay an initiation fee of $200,000 and $14,000 a year!
- Employer sponsored health insurance tax deductibility would end for plans above the 90th percentile in cost. This means a tax increase and lower take home pay for most salaried workers. This is proportionately a bigger deal for lower income families, for whom ESI represent a larger portion of total income.
- Let the states run Medicaid with little or no interference. Further, let's give them block grants with much less money. 19 states haven't expanded Medicaid even with full funding, and in some states eligibility for Medicaid requires making less than $4000 a year. What could go wrong?
- Segregate high cost people into their own "high risk pools." Actuaries say that would cost $175 billion in federal aid to stabilize such pools. Tom Price suggests $3 billion. Over three years!
There are a number of great summaries of the Republican plan:
- Timothy Jost in Health Affairs
- Sarah Kliff in vox.com
- John McDonough in healthstew.com
It's hard based on the grim statistics of the evolving Republican plans to get a sense of the human tragedies that the Affordable Care Act has prevented. These could come roaring back as soon as Congress acts. I think some of the most important reporting has been around powerful narratives of people who have benefited from the ACA - and who could be crushed by these proposals. I'll let you know tomorrow what I think are some of the most compelling stories current being told.
Even John Oliver can't make this funny
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