After promising for six years to offer a bill to repeal and replace the Affordable Care Act, House Republican leaders last week presented a white paper that House Speaker Paul Ryan called “a real plan, in black and white” to “make healthcare actually affordable.”
But several health policy experts questioned that description, given that the 35-page document contains few details and no numbers describing how much the proposal would cost, how it would be financed or how many Americans would gain or lose health insurance. Past presidential candidates including Barack Obama have laid out similarly vague campaign blueprints. Now, however, Ryan and his colleagues want to replace a law that has expanded coverage to 20 million Americans and helped slow spending growth.
“The difference between putting down principles and writing legislation is that when you write legislation, you have to commit to numbers and details,” said John Goodman, a veteran GOP health policy adviser who helped draft a recent Obamacare replacement bill sponsored by Rep. Pete Sessions (R-Texas) and Sen. Bill Cassidy (R-La.). He nevertheless praised parts of the House GOP package.
Several experts called the House GOP manifesto a rehash of old conservative ideas that Republicans have never seriously tried to implement. “It's no more a plan than saying, 'I'm going to build a house. Here's a stick-figure picture of it, and I can get it for you for next to nothing,' ” said Norm Ornstein, a veteran political analyst at the American Enterprise Institute for Public Policy Research.
There was skepticism about whether presumptive Republican presidential nominee Donald Trump would embrace it, particularly its politically volatile calls to cap Medicaid spending and turn Medicare into a defined-contribution program, exposing future retirees to higher out-of-pocket costs. During the primaries, Trump repeatedly criticized Ryan's past efforts to restructure and cut those programs, and blamed his proposals for Mitt Romney's loss in the 2012 presidential election. Some think Trump is likely to repudiate the Medicare part of the GOP plan, though other parts overlap with his own brief seven-point proposal.
“Ryan's Medicare voucher plan has been shown to be extremely unpopular in polls among people age 50 and older,” said Robert Blendon, a professor of health policy and political analysis at the Harvard School of Public Health.