It begins by repealing the ACA. Republicans propose to upend the health care system by repealing all provisions of the ACA they don't like and keeping the ones they do.
Here's a high-level overview of what they think our health care system should look like:
- Bring back pre-existing conditions - They do allow that if individuals maintain their coverage, they can't be excluded or subject to underwriting. This is a recycle of the old HIPAA continuation rules that were like COBRA on steroids.
- Charge older people 5 times what younger ones pay - That spread is currently limited to 3 times under the ACA.
- Roll back essential health benefits and all federal regulatory authority
- Block grant Medicaid, force states to use private insurers - Also, force Medicaid recipients to use a health savings account and high-deductible plan
- Sell insurance across state lines - This is what I like to call the "First Premier Credit Card Plan." Find the state with the least regulation and base all your business there.
- Reinstate state high-risk pools - Shovel the sick folks into their own high-risk pool to keep the costs low for everyone else...until they get sick too.
- Cut government subsides for premium costs in half - They also propose a sliding scale based on age and income.
- Expand health savings accounts
- Tort reform
- Automatic enrollment by states for all who don't enroll on their own - Can you say "Major Mandate?"
But hey, they do agree that kids under age 26 should be able to stay on their parents' health insurance plans and lifetime caps should be gone. So there's that.
They're going to pretend these ideas are somehow their answer to the Affordable Care Act, but nothing here is new. Not one thing. It's the same crappy proposals that caused people to go without health care access for so very long.
This is your Republican health care sleight of hand. They've rolled out junk so they can say they have an alternative, but the alternative is to return to the way it was before.
But it’s not nearly good enough. If Republicans had offered this plan as an opening bid in 2009, they might have found Democrats willing to make a counteroffer and negotiate toward some kind of compromise — or they might have knocked the whole legislative process off the rails. But in 2014, a plan that devolves crucial aspects Obamacare without any inducement for Democrats is a joke.
Yes, it's a joke. They'll use this to try and convince independents they're very, very serious about a replacement for the ACA. But the replacement is unserious, and anyone who has coverage under the ACA knows it.