Lots of ideas on how to replace certain aspects of the Affordable Care Act have been tossed around in the seven or so years since more right-leaning lawmakers, economists and policy experts began to gripe about the healthcare reform law. Here are some of the suggestions that might come in handy as GOP leaders draft a plan to be presented in the next few weeks. The goal is to introduce a bill before Congress takes a spring break in April.
Pick a Plan: How to replace the Affordable Care Act
- Caps federal Medicaid contributions to states based on the number of people enrolled, with payments rising by a fixed percentage regardless of medical cost growth.
- Repeals all ACA taxes that finance the law's premium subsidies, Medicaid expansion and Medicare benefit enhancements in favor of a new tax on employees for the value of employer-sponsored health benefits.
- Establishes refundable premium tax credits based on age rather than income, starting in 2020.
- Eliminates the ACA's minimum essential benefits package and allows states to regulate benefit levels.
- Repeals Medicaid expansion.
- Continues advanced premium tax credits for individual insurance market coverage, albeit with an altered age-based rather than income-based credit structure.
- Allows an insurance company to charge higher premiums to those with pre-existing conditions if an enrollee does not maintain continuous coverage for the18 months prior to enrollment.
- Allows individuals to purchase health insurance offered in another state, provided the insurer meets some basic requirements.
- Repeals the ACA's marketplace subsidies and eliminates the individual and employer mandates.
- Does not eliminate Medicaid expansion.
- Allows states to continue operating under ACA provisions with reduced federal funding.
- Allows individuals to receive tax credits to help them fund health savings accounts while insurers charge higher premiums for people with pre-existing conditions who don't maintain continuous coverage.
- Or states can reject federal assistance altogether while retaining some ACA coverage protections, such as a prohibition against annual and lifetime limits and a requirement to cover people up to age 26 on their parents' plans.
- Repeals the individual and employer mandates, essential health benefits requirements and medical loss ratio requirements.
- Maintains Medicaid expansion.
- Provides a two-year open-enrollment period under which individuals with pre-existing conditions can obtain coverage. After that they would still be able to gain coverage, but likely will have to pay higher premiums.
- Provides a $5,000 tax credit to individuals who contribute to health savings accounts.
- Repeals the ACA effectively as a whole, but doesn't reference repealing Medicaid expansion specifically.
- Ends the individual and employer mandates, essential health benefits provisions and the medical loss ratio requirement for insurers.
- Allows insurance to be sold across state lines.
- Repeals the individual mandate.
- Guarantees that no one can be denied coverage or charged higher premiums because of a pre-existing condition as long as they maintain continuous coverage.
- Repeals Medicaid expansion and converts the program to block grants.
- Provides income-related tax credits to low-income individuals and those who do not have access to employer-sponsored health insurance and to those who work in businesses with 100 or fewer employees.
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