Republican Plan to Replace Obamacare Crib Notes
The long awaited Republican vision for an alternative to the
Affordable Care Act, which was passed in 2010 was revealed yesterday by Speaker
of the House, Paul Ryan. Here are the key components of the plan compared to
existing provisions under the act, known as Obamacare.
Provisions
|
Republican Response
|
Affordable Care Act
|
Tax credits for buying insurance
|
Tax credits for all types of medical insurance, not just
exchange plans, credits regardless of income
|
Tax credits are offered to individuals buying medical plans
through state and federal exchanges and top out at incomes equal to 400% of
the federal poverty rate, in 2015 this was $46,680 for an individual and $95,400
for a family of four
|
Pricing of medical insurance plans
|
Encourage greater range of age-based pricing, lowering
cost for the youthful and jacking prices for older enrollees; presumably
females of childbearing years would also pay more
|
Insurance exchange plans have a ratio of 3 to 1 for the
range of highest rates to least expensive based on age; which means youth pay
a bit more and older individuals pay a bit less than under strictly age-rated
plans
|
Mandating Medical Insurance
|
Republicans would eliminate the mandate to purchase
medical insurance and keep the tax credits to for those who buy it
|
Mandating insurance coverage for all is a lynch pin of the
Affordable Care Act (ACA) and is a way to share risk over a greater number of participants than in
a strictly voluntary health plan pool
|
Health Insurance and High Risk Pools for the Sickly
|
Republicans would turn this responsibility back over to
the states and provide fixed budget support for 10 years
|
High risk pools were eliminated under the ACA, allowing chronically
ill enrollees to select from plans in the insurance exchanges; thanks to
removal of the pre-existing conditions clause, discriminatory benefit caps
and waiting periods
|
Medicaid
|
Republicans want to create block grants or fixed budgets
for state Medicaid programs, leaving it up to states to fully fund; similar
to a benefit cap
|
Under the ACA states were free to choose to recognize a
Medicaid eligibility expansion to 133% of the federal poverty rate; funding
is shared between the federal and state governments; states already have the
ability to file for Section 1115 Waiver Plans
|
Medicare
|
Increase cost sharing for all seniors on Medicare plans,
establish federal funding cuts in the future
|
Current Medicare plans provide some coverage without cost
sharing, a monthly premium for Medicare Part B, and private insurance for
Medicare supplements; high income seniors must pay more money for their
Medicare insurance
|
Population Covered by Medical Insurance
|
Republicans would reduce subsidies for low and moderate
income families, who would not be able to obtain medical insurance without
the advancement of tax credits; resulting in fewer people covered
|
Goal of the ACA was to increase the number of people with
access to health care, by offering more affordable insurance across the
nation; current level of insurance is 90% for the nation
|
Reimbursements for healthcare providers
|
Republicans would repeal the Disproportionate Share
Funding which provides subsidies to largely urban facilities which serve a
large number of low-income people; Republicans have refused to pay clinicians
the compensation they were promised for primary care services under the
ACA-using sequestration to block release of those funds
|
Disproportionate Share Funding or DSH was in existence
prior to the ACA for critical care hospitals (think urban trauma centers like Harborview), but was expanded
by the ACA as an incentive to get facilities to treat more Medicaid patients;
ACA also provided additional payments to doctors for the provision of primary
health care
|
References
Now that the Republicans have delivered a white paper on
their ideas for slowing the government spending on social programs and
increasing the out-of-pocket costs for many Americans, keep reading the
healthpolicymaven for more straight talk on issues that are important for you
and your family.
This article was written by Roberta Winter, the owner of the
trademark, healthpolicymaven and may be shared virally. She is the author of https://www.amazon.com/Unraveling-U-S-Health-Care-Personal/dp/1442222972
