The proposal was presented on Thursday to rank-and-file members. It leans heavily on tax credits to finance individual insurance purchases and sharply reduces federal payments to the 31 states that have expanded Medicaid eligibility.
Speaker Paul Ryan and two House committee chairmen stood with the new secretary of health and human services, former Rep. Tom Price of Georgia, preparing Republican lawmakers for a weeklong Presidents’ Day recess that promises to be dominated by angry or anxious questions about the fate of the Affordable Care Act. But the talking points they provided did not say how the legislation would be paid for, essentially laying out the benefits without the more controversial costs.
It also included no estimates of the number of people who would gain or lose insurance under the plan, nor did it include comparisons with the Affordable Care Act, which has extended coverage to some 20 million people.
With the House proposal’s rollback of Medicaid payments to the states, it appears probably that the number covered would be smaller.
Sketchy as the outline was, it envisions major changes.
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It would fundamentally remake Medicaid, a Great Society program that provides health care to more than 70 million Americans, not just the poor, but also middle-class people who have run out of money and need nursing home care. Under the plan, Medicaid, an open-ended entitlement program designed to cover all health care needs, would be put on a budget.
The Affordable Care Act’s subsidies, which expand as incomes decline, giving the poorer people more help, would be replaced by fixed tax credits to help people purchase insurance policies. The tax credits would increase with a person’s age, but would not vary with a person’s income.
And new incentives for consumers to establish savings accounts to pay medical expenses still assume that workers would have money at the end of a pay period to sock away.
The House Republican plan would also make it easier for consumers to buy health insurance from companies licensed in other states, an idea long promoted by Republicans in Congress and championed by President Donald Trump in his campaign last year.
After the recess, Ryan said: “We intend to introduce legislation to repeal and replace Obamacare. It has become increasingly clear that this law is collapsing. People’s premiums are getting higher and higher. Their deductibles are soaring, and their choices are dwindling.”
Price told House Republicans that Trump “is all in on this.”