WASHINGTON (AP) — Republicans are far from reaching a consensus over how they would replace President Barack Obama’s health care law, which reduced the nation’s uninsured rate to a historic low of around 9 percent but failed to win broad public support.
Dozens of GOP-inspired proposals are being bandied about on Capitol Hill, and it could take months or years to fully understand the costs and benefits of the complex changes that lawmakers are considering.
Whatever replacement GOP lawmakers choose may end up covering fewer people than the 2010 Affordable Care Act, or ACA. But Republicans are betting that their goal of “universal access” with fewer requirements will be more politically acceptable than the Democratic ideal of “universal coverage,” which put Washington in charge.
Here’s a look at the possible effects of some of the ideas put forth by Republicans:
REPEAL THE INDIVIDUAL REQUIREMENT TO CARRY INSURANCE OR RISK FINES
The so-called “individual mandate” is highly unpopular. Many of the uninsured who have ended up paying fines to the IRS are low-to-moderate income workers who are juggling rent, car payments and student loans. Experts debate how well the ACA’s mandate has worked in practice.
Insurers see the coverage requirement as a pillar of a revamped market in which they are required to accept people with pre-existing health troubles. How else, insurers ask, can they get enough healthy people in the coverage pool to balance out the risks?
Republicans have several ideas, including a one-time open-enrollment period for everyone who remains uninsured, and a requirement that people maintain “continuous coverage” in order to be guaranteed insurance on the same terms as everyone else. Those nudges stop short of a federal mandate.
HIGH-RISK POOLS FOR PEOPLE WHO CANNOT AFFORD OR GET PRIVATE INSURANCE
High-risk pools for some of the sickest patients could help lower premiums for average-risk customers in the broader individual market.
However, when they were tried previously, they didn’t work particularly well. The coverage has been expensive and the programs often had to limit enrollment. Republicans are proposing at least $25 billion worth of federal money.
TAX CREDITS SET BY AGE, NOT INCOME
The ACA’s tax credits are now set according to household income, and middle-class and upper-income people get little to nothing. One change Republicans are considering would set the tax credits according to age. People who don’t currently get any assistance because of their income would also be eligible.
There are no details yet concerning how the tax credits would work, including the amount of assistance provided. House Speaker Paul Ryan’s “Better Way” plan says it would be enough to buy “the typical pre-Obamacare” plan. Independent experts say the assistance could turn out to be pretty skimpy. A big concern is whether low-income people could afford coverage.
BLOCK GRANTS FOR MEDICAID
Taking steps to cap federal contributions to the federal-state health insurance program for low-income would limit the future growth of Medicaid. States would have more leeway to decide on their how they want to care for vulnerable people.
The consequences could be huge for the 70 million people now covered by Medicaid, including some 10 million who were added through the ACA’s expansion of the program. Because states’ programs come in a great variety, federal limits might lock in current disparities. In a budget crunch, states might cull hundreds of thousands of people from the Medicaid rolls, meaning hospitals would get stuck with the bill for emergency care.
FEDERAL LIMITS ON MALPRACTICE AWARDS
The nonpartisan Congressional Budget Office has concluded that limiting malpractice awards would modestly reduce health-care spending by big government programs. But limits of this sort could also add to the hardships suffered by patients who are most grievously harmed by negligent doctors and hospitals.
ALLOWING INSURERS TO SELL INDIVIDUAL POLICIES ACROSS STATE LINES
Interstate competition would help keep premiums in check. But health insurance is a local and regional service, and out-of-state insurers aren’t likely to have networks of hospitals and doctors beyond their territory. Many state regulators fear there might also be attempts to circumvent consumer protections.
LIMITING TAX BREAKS FOR EMPLOYER-PROVIDED HEALTH INSURANCE
Limiting federal tax breaks for the most generous employer plans would act as a brake on health -are spending, while also raising revenue for tax credits to help people buy insurance. This perennial idea has been a political loser. Unions are strongly opposed.