A key group of Republican leaders this week unveiled the latest attempt at an Obamacare replacement in a 9-page summary detailing what looks like a more compressed version of the current health care law. It’s an updated version of a proposal a small group of Republicans created a year ago.
The proposal, called the Patient Choice, Affordability, Responsibility and Empowerment Act, or Patient CARE, comes from three top Republicans: Senate Finance Committee Chair Orrin Hatch (UT); Sen. Richard Burr (NC); and House Energy and Commerce Committee Chairman Fred Upton (MI).
The plan keeps some of Obamacare’s more popular provisions in place – including allowing young people to stay on their parents’ plan until they turn 26 and prohibiting insurers from discriminating against those with pre-existing conditions. It also preserves subsidies for people to put toward health coverage, though it scales back the eligibility requirements so that fewer people would qualify.
Meanwhile, it would repeal the law’s individual and employer mandates, and scrap rules requiring all insurance plans to include certain benefits like maternity care and contraceptives. The three lawmakers suggest this would significantly reduce the cost of the health plans—especially for people purchasing bare-bones plans.
Repeal or Replace?
Republicans have been pledging for years to repeal and replace Obamacare. They’ve voted 60 times to dismantle the law and have promised to come up with a better alternative. The upcoming Supreme Court case scheduled this March that threatens to unravel the entire law has given the GOP a new sense of urgency.
But the majority of Americans say they want Congress to fix the law, rather than kill it. An earlier survey by Hart Research Associates and Public Opinion Strategies that found 54 percent of respondents say they want lawmakers to repair Obamacare, while 28 percent say they want to eliminate it. Another 17 percent say they want the law to remain as is.
Importantly, that fix-it sentiment is also now shared with one of the law’s original adversaries. The powerful Chamber of Commerce for the first time ever did not endorse the GOP’s latest repeal vote.
The Patient CARE plan is one way to fix the ACA according to its creators. It keeps federal subsidies, but lowers the eligibility threshold from 400 percent of the federal poverty level under Obamacare to 300 percent. That’s about $35,310 for a family of four and $24,250 for a childless adult.
“We agree we can’t return to the status quo of the pre-Obamacare world, so we equip patients with tools that will drive down costs while also ensuring that those with pre-existing conditions and the young are protected,” Sen. Hatch said in a statement.
The Republican plan also repeals the law’s Medicaid expansion and instead gives income-eligible people tax credits to put toward private insurance. It also proposes to convert Medicaid into a “per-capita cap,” similar to block grants.
It also increases price transparency. It would require hospitals accepting Medicare to, among other things, disclose the “average amount paid by uninsured and insured patients for the most common impatient and outpatient procedures.”
While this is probably the closest thing to an actual Obamacare replacement plan, it is unclear in terms of what would happen to the millions of people getting coverage through the current health law. Since it’s an outline and not an official piece of legislation yet, it can’t be scored by the Congressional Budget Office – so the group will need to come up with more details and formalize the plan.
Separately, another group of GOP lawmakers—led by House Budget Committee Chairman Paul Ryan -- is working on a plan of their own.
The outline comes one month before the Supreme Court hears King v. Burwell, the much-anticipated case that has the potential to dismantle the entire health care law. If the High Court strikes down the federal subsidies to the millions of people getting coverage through the federal exchange, the entire law could crumble.
GOP lawmakers are eying the case as their only realistic shot at repealing Obamacare. The Court will make its decision in June. Until then, Republicans are working on getting a replacement strategy in place.
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