House GOP Releases Plan to Repeal and Replace the ACA
On Wednesday, Speaker of the House Paul Ryan (R-WI) and other House GOP leaders unveiled their alternative to President Obama’s signature health care law, the Affordable Care Act (ACA). While the plan does not include a number of specific details including the overall cost and total number of covered individuals, it does present a broad outline of a potential GOP health reform agenda for the next administration. As in the past, this initiative includes a number of proposals that would directly repeal ACA provisions as well as revamp current practices in Medicare, Medicaid and marketplace health care coverage.
Key provisions of the plan include:
- Medicaid Reforms – Under the plan, the federal government would adopt a per-capita funding scheme for Medicaid beginning in 2019. Each state’s capped allotment would be based on the number of enrollees and their health status, age, and life circumstances. Funding for health grants would be allocated to states based on the number of low-income enrollees at or below 100 percent of FPL. States would receive a defined budget for long-term care services and support for low-income elderly or disabled individuals who do not avail themselves of the tax credit. The Children’s Health Insurance Program (CHIP) funding would return to “historical” levels of funding that does not include the ACA’s 23-percent enhanced match.
- Medicare Reforms – The plan would repeal both the Medicare Advantage (MA) benchmark caps and the Center for Medicare and Medicaid Innovation (CMMI). It aims to give plans greater flexibility to design benefits and create new mechanisms and tools for beneficiaries to compare MA and traditional fee-for-services for each geographic region on a core set of quality measures. The plan would also raise the Medicare eligibility age beginning in 2020 to gradually correspond with the Social Security eligibility age.
- Individual Mandate, Pre-Existing Conditions – The plan would repeal the individual mandate and provide states with flexibility to pursue alternative solutions. The plan would also prevent insurance companies from denying coverage to patients based on a preexisting condition if the patient is continuously enrolled in a health plan.
- Innovations in Health Care– The plan seeks to accelerate the discovery, development, and delivery of new treatments and cures for patients, specifically including some provisions of the 21st Century Cures Act. Such provisions include: increasing research collaboration, while protecting patient privacy; incorporating the patient perspective into FDA’s drug development review process; and reforming rules for electronic health records and meaningful use.
- Additional Insurance Reforms and Regulations – The plan recommends a number of options including: facilitating private exchanges and defined contribution methods; capping the tax exclusion for employer-sponsored health insurance at “a level that would ensure job-based coverage continues unchanged for the vast majority of health insurance plans”; and enabling the purchase of insurance across state lines and facilitating interstate compacts.
To be clear, these provisions are not yet in legislative text and no repeal and replace bill of this nature is currently being considered by the House of Representatives. This agenda, crafted largely by Speaker Ryan, aims to serve as a platform for the GOP moving forward into 2017 and the next Administration and Congress.