How Do The Plans For Replacing Obamacare Measure Up?

The repeal and replacement of the Affordable Care Act is one of the most hotly debated items on the Trump administration’s agenda. While some insist there must be a full repeal now, others maintain that there should be no repeal until there is something in place to go into effect immediately upon repeal.

While Republicans hash out the best course of action, regarding implementation, they are not without plans.

The problem remains with which plan would serve American citizens best.

Currently, plans put forth by House Speaker Paul Ryan and Trump’s Health and Human Services pick, Rep. Tom Price, seem to be the top draws in the debate.

The Ryan plan, dubbed “A Better Way,” has been around since last year, and is mapped out in this manner:

  • Americans without employer coverage: provides a refundable tax credit, based on age, to buy coverage on private exchanges.
  • Americans with employer coverage: expands the use of tax-free health savings accounts. Caps the tax exclusion for employer-sponsored coverage to incentivize buying lower-cost plans.
  • Americans with Medicaid: starting in 2019, gradually phases down extra federal money for expansion population until it reaches a state’s normal level. States can choose either a per capita allotment or block grant from the federal government to help fund their Medicaid programs.
  • Americans with pre-existing conditions: gives states at least $25 billion to set up high-risk pools. Insurers must accept people with pre-existing conditions during a one-time enrollment period. After that, coverage is only guaranteed to those who maintain it continuously.

Rep. Price’s plan is titled, “Empowering Patients First Act.”

  • Americans without employer coverage: get refundable, age-adjusted tax credits to buy coverage. Provides $1,200 for those ages 18-35, $2,100 for those 35-50 and $3,000 for those older than 50.
  • Americans with employer coverage: expands the use of tax-free health savings accounts. Caps the tax exclusion for employer-sponsored coverage, at $20,000 for a family and $8,000 for an individual, to incentivize buying lower-cost plans.
  • Americans with Medicaid: repeals Medicaid expansion.
  • Americans with pre-existing conditions: gives states funds for high-risk pools. Doesn’t guarantee coverage for those with pre-existing conditions, but awards bonus grants to states that guarantee coverage for those with prior employer coverage.

Interesting.

If neither of those are to your liking, there are at least four other plans that have been offered.

Last week, Kentucky Senator Rand Paul unveiled his plan to replace the ACA, simply titled, “The Obamacare Replacement Act.”

  • Americans without employer coverage: Individuals can get group coverage through independent pools. Anyone can save unlimited amounts in health savings accounts. Tax credits of up to $5,000 for an individual and $10,000 for a family would go into an HSA.
  • Americans with employer coverage: replace tax exclusion with universal deduction for everyone. Same access to HSAs and tax credits as those with individual coverage.
  • Americans with Medicaid: repeal Medicaid expansion.
  • Americans with pre-existing conditions: Those with pre-existing conditions get a two-year period to enroll in coverage, but they must continuously maintain coverage after that.

The Republican Study Committee plan is called “The American Health Care Reform Act,” and is spelled out, as follows:

  • Americans without employer coverage: get a tax deduction for buying insurance; $7,500 for individuals and $20,500 for families. Only helps if they earn enough to pay taxes.
  • Americans with employer coverage: get a tax deduction for buying insurance on their own instead of through their employer. Also expands the use of tax-free health savings accounts.
  • Americans with Medicaid: repeals Medicaid expansion.
  • Americans with pre-existing conditions: provides $25 billion over a decade for state-run high risk pools. Insurers must cover those with pre-existing conditions as long as they maintain continuous coverage. Customers can switch insurers, but they cannot have a gap between coverage.

 

There seems to be a theme with allowing for no gap in coverage.

Senators Bill Cassidy and Susan Collins’ plan, “Patient Freedom Act” would keep Obamacare in place, using the extra federal dollars for either tax-free savings accounts or alternative designs without federal assistance.

  • Americans without employer coverage: get a tax-free health savings account, a high-deductible health plan and a basic pharmacy plan. They get a grant or refundable tax credit to go into their savings account. To pay for the subsidies, states get 95 percent of the federal dollars currently provided through Obamacare.
  • Americans with employer coverage: keep tax exclusion.
  • Americans with Medicaid: States can decide to keep their Medicaid expansion or use the extra federal funds to help people buy private plans.
  • Americans with pre-existing conditions: Insurers are required to cover them.

Finally, Senator Lamar Alexander, of Tennessee, proposed a plan earlier in January, and didn’t give it a spiffy name. It’s just his plan. Still, some may find it more appealing than the other alternatives.

  • Americans without employer coverage: allow people to use Obamacare subsidies for coverage outside the marketplaces. Allow states more flexibility in their marketplaces through the law’s waivers. Expand health savings accounts.
  • Americans with employer coverage: keep tax exclusion.
  • Americans with Medicaid: Give states more flexibility through Medicaid waivers.
  • High-risk Americans: Insurers are required to cover them.

A lot of people have been sorely burdened by the ACA, which has inflated costs and forced them to choose between paying the rent or paying to avoid the stiff government penalties associated with not choosing a plan.

Then there are the men wondering why they had to pay for maternity care.

The Trump administration has yet to announce what will be done about Obamacare, but repealing it seems to be the one thing a divided party can agree needs to be done, ASAP.