House Republicans produced a white paper last week that provides some information on the types of health care policies they would pursue after passing legislation to repeal the Affordable Care Act (ACA).
Culled primarily from prior Republican proposals, the patchwork of reforms would:
Replace current ACA premium subsidies with a refundable tax credit for Americans without employer-provided care.
Expand health savings accounts.
Use “high-risk pools” to cover the sickest Americans.
Limit Medicaid funding by block grants or per-capita payments to states.
For those not yet retired, move Medicare to a “premium support” system in which beneficiaries would receive money to purchase private insurance.
Unfortunately, it is impossible to gauge the budgetary impact of the proposals because the white paper left out key details, financial thresholds, and funding mechanisms and levels. This also makes it impossible to project how many people would lose health insurance.
A key funding mechanism that is included in the white paper — a cap on the amount of tax-free health insurance through an employer — is nearly identical to the ACA’s “Cadillac Tax” that House Republicans have argued against and delayed through legislation passed last fall.
This suggests that while the conference might support politically popular pieces of a reform plan, support for the tough choices required to make those popular parts work will be harder to come by.
Also worrisome in the framework is the call to repeal key cost-control efforts through Medicare’s innovation center, which is playing an important role in testing ways to slow health-care inflation without harming health.
House Republican Health Care Plan
Concord Coalition on Cadillac Tax Delay