Conservatives Want to replace Obamacare.  They’ve published a  policy paper on dismantling the Affordable Care Act (ACA) from House Speaker Paul Ryan (R-Wis.).  The current GOP proposal, “Obamacare Repeal and Replace: A Policy Brief and Resources,” was released on February 16.

A post by Shannon Firth, Washington Correspondent for MedPage Today suggests that health policy experts, from both sides, “are not impressed.”

“It’s a repackaging of ‘A Better Way’,” said Kavita Patel, MD, a nonresident fellow in economic studies at the left-leaning Brookings Institution, referring to the alternative ACA plan Ryan released in June 2016.

Joe Antos, PhD, of the conservative American Enterprise Institute in Washington, agreed that the new document was “largely the same” as the previous one. However, he did note one difference — “The word Medicare doesn’t appear at all” in the current policy paper.

“Medicare has always been the piggy bank for health policy,” he pointed out.

Shannon reports that “Patel, who is also a primary care physician at Johns Hopkins Medicine in Baltimore, suggested the impetus for Ryan’s policy paper was the House Freedom Caucus’ push for the speedy repeal of the ACA; Ryan felt compelled to stake his claim, she hypothesized”  I agree with Shannon’s conclusion here since the Freedom Caucus put forth its own plan for a fast-tracked repeal on February 15.

“It would be nice to have more details, but what details are there are troubling,” particularly for vulnerable populations, such as low income families that depend on subsidies and on the Medicaid expansion, Patel added.

When people begin to talk about turning health insurance purchase into a tax credits, it’s highly likely people will lose coverage, she added.

“How many of the 21 million people who have been insured since the ACA started would lose their insurance?” Patel stated. “We don’t have that answer.”

Another expert

Antos said the lack of mention of Medicare doesn’t mean that there won’t be changes to program, but they will likely involve financing any reforms.  As for “voucherizing” Medicare, that’s “a dead issue,” he said.

As for the plan put out by the House Freedom Caucus, led by Rep. Rand Paul (R-Ky.) and Rep. Mark Sanford (R-S.C.), it recommends repealing Medicaid expansion, de-linking health insurance from employers, and offering a $5,000 tax credit which beneficiaries could invest in HSAs, according to the Washington Post.  The Caucus wants “a clean repeal” of the ACA, and has suggested using the budget reconciliation bill that President Obama vetoed last year.

“What exactly is in a clean repeal?” Antos said. “[Republicans] are all speaking at a level of generality that doesn’t lock anybody into anything yet.”

The GOP Plan suggest that their proposal would “ensures more choices, lower costs, and greater control over your health care.”  I strongly disagree.

Here are the key points in the GOP Plan and my comments:

  • The GOP Plan says it “Moves health care decisions away from Washington and to where they belong: with patients, their families, and their doctors.”
    • The key for me is that there is no mention of Insurance Companies in this comment.  They say they want to move decisions from Washington (Washington is always the bogieman/whipping boy/scapegoat for conservatives) to patients, families, and doctors.  But they leave out Insurance companies.  I don’t decide what I care I get the Insurance companies get to decide.  Which may not be a bad thing if there is competition between insurance companies and transparency of the doctors and insurance companies.  But, since there is no transparency, consumers cannot make the decisions the GOP Plan says we should make.
  • The GOP Plan says it “Provides coverage protections and peace of mind for all Americans—regardless of age, income, medical conditions, or circumstances.”
    • No it doesn’t.  Any evaluation of the plan leads to the reasonable conclusions that their plan will “guarantee” none of those things.  
  • The GOP Plan says it “Gives patients the right tools, like Health Savings Accounts, to make their health insurance more portable and affordable.”
    • This is laughable on its face.  HSAs do nothing to make insurance more portable or affordable.  I could be wrong here, but I don’t think so.  The supporters of this bill need to provide the details of how HSAs make insurance more portable and affordable.
  • The GOP Plan says it, “Allows those who don’t receive insurance from an employer or government program to have access to quality coverage.”
    • Again, this is laughable on its face.  They need to explain what they consider “quality coverage” and how the plan provides more access to the plans.  Plus, and I love this one, in their first bullet they talk about doing away with government, yet in this bullet they talk a government program.  It confuses the hell out of me.
  • The GOP Plan says it, “Breaks down barriers that restrict choice and prevent Americans from picking the plan that is best for them and their family,
    • Name that tune!  How does your plan do this.  This is a great example of what Dr. Patel says is a lack of details.  
  • The GOP Plan says it, “Modernizes and strengthens Medicaid to protect the most vulnerable.”
    • From my perspective this is simply a lie.  And they hope no one calls them on it.  They do not want to strengthen Medicare or Medicaid.  They believe that Socialized Medicine is a bad thing.  They believe that poor people abuse these benefits and that the only way to stop the abuse is to stop the benefits. The new policy paper actually states that the enhanced match rate for Medicaid expansion states — the ratio of funding states receive from the federal government for the expansion population — will drop to the regular match rate at “a date certain,” Antos said.


My reading of this policy paper is that it is not a true plan, but has elements that will become a plan.

Here are some of the questions about the policy paper that need answers:

  • What will the refundable tax credits look like?
  • How does the refundable tax credit increase with age?
  • At what point will employer sponsored insurance be taxed and at what rate?
  • How will the plan affect gender rating, the practice of charging men and women different prices for healthcare based on their gender?
  • If you cannot afford to pay will you not get treatment?
  • Is pregnancy a preexisting condition?