Republicans roll out their Obamacare replacements

Some lawmakers want to provide people with tax credits to buy coverage, while others want deductions. Some House conservatives are suspicious of phasing out Obamacare gradually. And a growing group of senators are stressing that replace must happen at the same time as repeal.

The party is united around the idea that there must be some sort of healthcare reform, but it’s divided over how quickly to repeal the law, how long it should take to phase out and whether a replacement needs to be passed at the same time.

In short, the pathway is there for Republicans to repeal and possibly replace the Affordable Care Act, but it’s a rocky, pothole-filled road.

Two plans, one offered by House Speaker Paul Ryan and the other from Health and Human Services Secretary nominee Tom Price, are expected to be the most important guides to a replacement. Here’s a rundown of those proposals and several other ideas Republicans have suggested in the months since repealing Obamacare became a possibility.

The Ryan plan (“A Better Way”)

Envisioning a future Republican president, Ryan insisted last year that his members craft an Obamacare replacement framework. It’s little more than a broad blueprint, but it draws from many longstanding conservative ideas to reform healthcare and points in the direction GOP leaders want to go.

• 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.

The Price plan (“Empowering Patients First Act”)

Rep. Tom Price, who is undergoing the Senate confirmation process to lead HHS, has repeatedly introduced his plan ever since the Affordable Care Act was being crafted in 2009. Now that he’s in a key role, his plan is expected to get strong play in the replacement debate.

• 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.

The Republican Study Committee plan (“The American Health Care Reform Act”)

• 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 plans.

The Cassidy/Collins plan (“Patient Freedom Act”)

Last week, Sens. Bill Cassidy and Susan Collins announced a plan that allows state to keep Obamacare as is, use its extra federal dollars for tax-free health savings accounts or design their own alternative without any federal assistance. Here’s how it would work, if states choose the option of setting up tax-free accounts:

• 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.

The Lamar Alexander plan

Sen. Lamar Alexander of Tennessee has been adamant that Congress shouldn’t repeal the healthcare law without concrete steps to replace it, to ensure people don’t lose coverage. Earlier this month he outlined a transition plan.

• 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.

The Rand Paul plan (“The Obamacare Replacement Act”)

Sen. Rand Paul of Kentucky laid out his own proposal last week, drawing from many of the other GOP plans.