Republican Plan to Replace Obamacare-A Brief Comparison

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

https://www.washingtonpost.com/news/powerpost/wp/2016/06/22/republicans-have-a-plan-to-replace-obamacare-and-its-costs-are-unclear/

https://www.irs.gov/affordable-care-act/individuals-and-families/questions-and-answers-on-the-premium-tax-credit

http://kff.org/other/state-indicator/total-population/

http://healthaffairs.org/blog/2014/01/30/opting-out-of-medicaid-expansion-the-health-and-financial-impacts/

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