Let’s be clear. The Republican majority with the ability to pass a repeal and replacement of Obamacare just taken office a few weeks ago. So it seems odd that the Democrats are accusing them of failing to put forth a replacement plan for Obamacare. After all, these things are supposed to take time and it might be a good idea to think it out a little longer than the Democrats did.
Republicans in both the House and the Senate have unveiled a number of proposals to replace Obamacare in the years since Barack Obama signed the ACA into law. They never got out of committee, but most share some key provisions … offering tax credits to consumers, expanding the use of health savings accounts or reforming Medicaid.
They say the devil is in the details and the strengths and weaknesses of each proposal can be found there. There are at least four plans being crafted to replace the law. I plan to focus on the Cassidy-Collins bill later, but basically, it repeals only Obamacare’s mandates, maintains its subsidies and taxes and allows states that like Obamacare to keep Obamacare.
In addition to the Cassidy-Collins plan, there are proposals offered by Paul Ryan and the Republican conference; Rep. Tom Price, R-Ga., who is now President Trump’s Secretary of Health and Human Services; the Republican Study Committee; and Sen. Richard Burr of North Carolina, Sen. Orrin Hatch of Utah, and Rep. Fred Upton of Michigan.
Price’s Empowering Patients First Act offering age-adjusted, refundable tax credits and individuals can opt out of the government health care programs and receive the tax credit instead. It creates a one-time, refundable tax credit for HSA contributions and increases the amount of money individuals and families can contribute. It caps the tax exclusion at $20,000 for families, $8,000 for individuals. It requires insurers to provide coverage to those with pre-existing conditions if the patient has had coverage for at least 18 months. It also creates high-risk pools and allows consumers to purchase insurance plans across state lines.
House Speaker Paul Ryan and the House Republican Conference have proposed A Better Way for Health Care. It also offers age-adjusted, refundable tax credits and health savings accounts. It also expands access to HSAs for BIA benefit and Tricare recipients. It caps tax exclusions for employer-sponsored coverage. It requires insurers to provide coverage for pre-existing conditions for those maintain continuous coverage and it creates high-risk pools. It allows consumers to purchase plans across state lines and covers dependents on their parents’ plans until age 26. It also reforms Medicaid.
The Republican Study Committee also came out with the American Health Care Reform Act of 2017 which allows tax deductions for individuals and families, health savings accounts that include Indian Service or Tricare and allows HSAs to be used for long-term care, premiums for HSA-qualified plans and Cobra. Of course, it requires insurers to provide coverage to those with pre-existing conditions who maintain continuous coverage and it creates high-risk pools. It also allows consumers to purchase plans across state lines.
Senators Richard Burr and Orrin Hatch and Representative Fred Upton have comes out with the Patient CARE Act. It also provides age-adjusted and income-based tax credits and expands health savings accounts to BIA benefit holders, as well as allowing consumers to use HSAs to pay for COBRA and premiums for HSA-qualified plans. It caps the tax exclusion on employer-sponsored coverage at $30,000 per family. It coverages pre-existing conditions and creates high-risk pools. It allows consumers to purchase coverage across state lines and keep their kids on the family plan until age 26. And of course, it reforms Medicaid.
All four of these proposals are basically the same bill with somewhat different details, so I am not going to focus on them beyond this brief coverage (unless Rick comes up with something he wants to share). All of them share an element that could work. It’s similar to a suggestion Ben Carson made at the Prayer Breakfast that made him a conservative darling. In his suggestion, he recommended annual deposits by the government from birth to whenever that you can pass onto your kids. That is similar to something parents here in Alaska can do with a portion of the Permanent Fund Dividend to fund an Education Fund for their children. I know young people who are attending college without debt now using these accounts.
But I have issues with them because they really don’t go far enough. More on that later.