Roy's 68-page tome (PDF) lays out policies that he says would repair problems “caused by the ACA and those that predate it.” It would significantly restructure Medicare and Medicaid and achieve many of the long-term changes in those social insurance programs that Republicans such as House Budget Committee Chairman Paul Ryan (R-Wis.) seek.
Roy's plan would repeal the individual mandate, which requires all consumers to buy insurance or face a tax penalty—a policy that actually has deep conservative roots. Roy would replace the mandate and Obamacare's annual three-month open enrollment with a six-week open-enrollment period every two years, giving people a strong incentive to voluntarily sign up rather than having to wait two years if they happen to get sick.
Federal premium subsidies would phase out at 317% of the federal poverty level instead of the current 400%. Cost-sharing subsidies would be converted to health savings account contributions.
Avikcare also strips down exchange regulations so insurers can create plans that “are more attractive to consumers,” or those that are cheaper, but have fewer covered benefits. Insurers would be allowed to charge older Americans premiums six times as high as younger people, compared with the current 3-1 differential. Insurers still would have to accept people with pre-existing conditions without charging them more based on their health status.
Roy would gradually raise Medicare's eligibility age to 75, shift most Medicare and Medicaid enrollees onto the exchanges, repeal various taxes including the medical-device tax, allow physician-owned hospitals to proliferate again, shift the Veterans Health Administration to HHS and increase federal reviews of hospital mergers.
The plan would have the federal government pick up the full tab for Medicaid. But states that accepted the federal funding would have to take full responsibility for long-term-care funding and administration, including nursing homes.
Roy says his plan would save the government $8 trillion over 30 years and increase health coverage by 12.1 million people compared with ACA projections. We don't know what the Congressional Budget Office would say about that.
The debate over whether Roy's plan offers better choices for the American people and improves the U.S. health system is for another day. The more immediate question is whether his ambitious plan is politically palatable to Republicans.
Roy's proposal almost certainly will not appeal to members of the tea party faction, which vehemently opposes any government involvement in healthcare. Avikcare still involves a considerable amount of federal intervention, though less than the Affordable Care Act.
This week, Roy wrote in Politico that “conservatives don't have to repeal Obamacare to advance their principles.” But that may be a tough sell to conservatives who are going into the November congressional elections with their minds already made up to pull Obamacare out by the roots, with no intention to plant anything in its place.
Follow Bob Herman on Twitter: @MHbherman
