A leaked draft of a House bill to repeal and replace Obamacare fills in important new details of how Republicans would remake the healthcare law.
The discussion draft, which is dated Feb. 10, envisions phasing out big parts of the Affordable Care Act by 2020, including rolling back its Medicaid expansion and switching its insurance subsidies from income-based to age-based.
It also seeks to ease regulations on insurers, eliminating the federal list of essential health benefits they must cover and directing states to write the rules instead. It allows insurers to charge older people up to five times what they charge younger people, instead of just three times. And while it gets rid of the law’s mandates to buy coverage, it says insurers may charge consumers 30 percent more in premiums if they don’t maintain continuous coverage.
Republicans already had outlined many of the draft’s main provisions, including its expansion of tax-free health savings accounts, restrictions on subsidies for plans covering abortion services and repeal of the healthcare law’s taxes.
But they hadn’t said how big the subsidies would be for people without employer-sponsored coverage — a key decision that ultimately will affect how many of the uninsured get coverage.
According to the draft text, refundable tax credits to pay monthly premiums would be available in five sizes depending on the enrollee’s age. For example, someone under age 30 would receive $2,000 a year, while someone over age 60 would get double that amount. Enrollees could deposit any unused subsidies into a tax-free health savings account.
Under the plan, first reported by Politico, states could keep their expanded Medicaid programs but would receive less federal money for the new enrollees starting in 2020. Federal Medicaid payments to states would be capped based on the number of enrollees.
The plan would be paid for chiefly with the savings from Medicaid rollbacks and by capping the tax break for employer-sponsored coverage. It’s not clear how much the plan would cost or how many people would be covered under it, as the Congressional Budget Office hasn’t released a score. It also isn’t clear if the provisions would be approved under reconciliation, which requires legislation to deal only with budget and spending levels.
The text adheres closely to the “Better Way” proposal released by House Speaker Paul Ryan last summer, which laid out how Republicans could replace the healthcare law with their own ideas. House committees are still working on the plan and expect to start marking up the legislation next month, although no hearings have been announced.
The legislation includes a number of anti-abortion provisions. It says federal subsidies couldn’t be used to buy plans that cover abortions and blocks Planned Parenthood clinics from receiving Medicaid reimbursements.
