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House Republicans Offer Their Vision for Healthcare

Plan would repeal Obamacare, provide refundable tax credits

Speaker Paul D. Ryan said he "completely" disagreed with presumptive Republican presidential nominee Donald Trump's comments on the judge who ruled in the Trump University case. (Al Drago/CQ Roll Call file photo)
Speaker Paul D. Ryan said he "completely" disagreed with presumptive Republican presidential nominee Donald Trump's comments on the judge who ruled in the Trump University case. (Al Drago/CQ Roll Call file photo)

House Republicans would repeal the Affordable Care Act but provide the uninsured a grace period to purchase health insurance and qualify for protections that would prevent health care costs from rising significantly, under a GOP blueprint released Wednesday.  

The 37-page health care policy paper is part of House Republicans’ “A Better Way” agenda. The formal unveiling of the health care blueprint Wednesday will mark the fifth release in the six-part agenda. The final paper, outlining House Republicans’ ideas for rewriting the tax code, will be released Friday.  

The GOP health care plan starts by repealing President Barack Obama’s signature legislation, known as Obamacare, including all its mandates and penalties. The uninsured will not be penalized for electing not to purchase insurance under the GOP plan.  

A one-time, open enrollment period will allow individuals to choose among health care plans already available in the marketplace without facing higher costs because they’re uninsured or sick. Those who decide not to obtain coverage during the open enrollment will be able to purchase insurance it the future but likely at a higher cost, the policy paper says.  

Individuals and families who already have insurance and those who obtain coverage during open enrollment will qualify for “continuous coverage protections” that ensure as long as they remain enrolled in a health care plan they won’t have to pay more than standard rates, even if they get sick.  

“This new safeguard applies to everyone who remains enrolled in a health insurance plan, whether the individual is switching from employer-based health care to the individual market, or within the individual market,” the paper says.  

The ideas in the paper come from a variety of health care proposals Republicans have introduced over the past several years. The paper lists 66 bills – among more than 400 health care bills introduced in the 114th Congress – from which some of the proposals were drawn.  

These include a refundable tax credit, a cap on how much an individual can deduct for insurance costs and “conscience provisions” related to such health services as abortion.  

Democrats dismissed the plan before it was even released. “What we expect from the latest Republican blueprint is more of the same – recycled proposals that would take health care away from millions of Americans without any real trace of an alternative,” Ways and Means ranking member Sander Levin, D-Mich., and health subcommittee ranking member Jim McDermott, D-Wash., said in a statement.  

One of the central pieces of the GOP plan is a refundable tax credit that individuals and families who do not have access to coverage through their employer or through Medicare or Medicaid can use to purchase insurance in the private marketplace. The credit will be given to taxpayers in advance through a portable payment available at the beginning of every month.  

Although the blueprint does not specify the amount of the credit, it says it will be “large enough to purchase the typical pre-Obamacare health insurance plan.” After purchasing insurance, taxpayers would be able to deposit any leftover portions of the credit into a health care expense account similar to a Health Savings Account.  

The policy paper leaves out key details, like how much the proposal would cost and how Republicans would offset the costs. A senior House Republican leadership aide said that taken together the policies the paper outlines would reduce the deficit.  

The blueprint is meant to provide a framework and a general sense of what a GOP health care system would look like without hamstringing the committees that would write the actual legislation, the aide said. “It’s not prescriptive in saying there’s going to be one bill or multiple bills.”  

Among the few detailed proposals the blueprint outlines is a plan to dedicate at least $25 billion in funding over 10 years for “high-risk pools” that provide financial assistance to people who can’t afford insurance.  

“There is a belief that we should have a strong and robust safety net,” the leadership aide said. Putting enough federal resources behind the high-risk pools will ensure people with preexisting conditions or other medical conditions that make their insurance more expensive can afford to buy coverage without impacting the market in a way that raises premiums for everyone else, the aide said.  

In addition the $25 billion cost of the high-risk pool programs, the Republicans are also proposing to spend at least $25 billion on State Innovation Grants that reward states for developing policies that lower premiums and the number of uninsured.  

While many of the proposals the Republicans outline will cost money, one idea in the paper that would likely raise revenue is capping the amount of employer-sponsored insurance that can be deducted from individuals’ gross taxable income. Currently there is no limit to the exclusion.  

The paper does not specify where the cap would be set but says “the vast majority of health insurance plans” would not be affected. “It’s likely that most health plans would change their design to avoid hitting the threshold by shifting compensation away from health care and toward take-home pay,” it reads. “As a result, Americans would have more money in their pockets and face lower premiums as a result of this policy.”  

Conservative sweeteners, like “conscience protections” for health care providers who choose not to cover abortion services, are also included in the blueprint.

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