A group of conservative House Republicans on Wednesday unveiled an Affordable Care Act replacement plan that would increase access to health savings accounts, expand federal support for states to establish high-risk pools, and allow insurers to sell health plans across state lines.
The 184-page bill, titled “The American Health Care Reform Act of 2017,” also aims to “level the playing field” between those who get their insurance from employers and those who purchase it individually by creating a standard tax deduction for health insurance.
The legislation has been previously introduced without much support from Republican leadership. But given the push to find a way to replace the ACA, it could draw the attention of other House Republicans
“Obamacare, for all the talk of collapsing markets and soaring premiums, has stripped individuals across this country from the most important decision we may ever face, and that is the decision regarding our own healthcare,” Rep. Mark Walker (R-N.C.), chairman of the very conservative Republican Study Committee, which released the bill, said during a press conference Wednesday. He later said the committee's plan is “round 1” in what's likely to be a long battle to wrest health care decisions out of the hands of bureaucrats.
The House Republicans released the plan following the Senate's procedural vote earlier in the day that kicks off debate on a budget resolution that will act as a vehicle to repeal the ACA. That bill was introduced Tuesday just hours after members of the 115th Congress were sworn in.
Also on Wednesday, President Barack Obama and Vice President-elect Mike Pence visited Capitol Hill to rally their parties for the ensuing battle over the health care law.
Taking aim at Democratic lawmakers who have said that Republicans will repeal the ACA with no set replacement plan, Rep. Phil Roe (R-Tenn.), argued, “That's absolutely false. We have a plan.” Roe said he's “willing to listen to Democrat ideas about this, to amendments to this bill, as opposed to what they did, which is completely shut the other side out.”
However, when asked whether the committee aims to repeal and replace the ACA simultaneously, Walker said the committee doesn't yet “have the full timeline as far as replacement.” Rep. Bill Flores (R-Texas) said those who have gained coverage under the ACA could rest assured they would be safe during a transition.
Experts worry that repealing the law without an immediate replacement could collapse the already struggling individual insurance market, leaving up to 30 million without insurance.
The Republican Study Committee's plan is similar to House Speaker Paul Ryan's replacement pitch. It also contains many of the same components of a plan released by the committee in 2015.
The bill would fully repeal all aspects of President Barack Obama's signature health care law effective January 1, 2018, if enacted.
It emphasizes broad use of health savings accounts, which have figured prominently in other conservatives' proposals. Some experts question whether low-income people can afford to contribute to HSAs to make them useful.
The plan would allow individuals enrolled in Medicare or Tricare, or who get care from the Veterans Affairs or Indian Health Service to use and contribute to HSAs. It also expands what services can be purchased using HSA tax exempt funds, and increases the maximum contribution people can make toward their HSA to an amount equal to the annual limit of their out-of-pocket expenses.
The plan would, however, prohibit people from paying for abortions with their HSA funds, except in certain cases.
The American Health Care Reform Act of 2017 also takes a bite out of the tax provision that excludes employer-sponsored health benefits from income and payroll taxes. Instead, it creates a standard tax deduction for health insurance of $7,500 for individuals and $20,500 for family coverage.
“(That standard deduction) will give families flexibility to pick coverage that best fits their needs and ensure that the tax benefit for insurance doesn't go away if you lose or change jobs,” the bill reads.
Employer groups would likely vehemently challenge any proposal that would chip away at the tax exclusion, which has allowed employers to sponsor insurance while reaping tax benefits. An estimated 155 million Americans get insurance through their employers.
The committee's plan would also expand federal support to $25 billion over 10 years to help establish state high-risk pools that would provide coverage for people with preexisting conditions, as long as they maintain continuous coverage. It would cap premiums in those plans to 200% of the average premium in the state.
And to promote competition, the legislation would allow insurers to sell policies across state lines — once a favorite talking point of President-elect Donald Trump. Insurance experts question whether the idea is feasible. Some say it would undermine state regulations and lead to an unbalanced risk pool.
Finally, the bill also seeks to reform medical liability law and expand wellness programs.