Of course...

GOP framework for Obamacare replacement is short on details

'I don’t think Jesus could get everyone to agree,' on Obamacare replacement plan, says one House Republican.  (Of course Jesus could just wave his hand and get rid of sickness... But only if he really exists...)

By Jennifer Haberkorn

Seven months before President Barack Obama leaves the White House, congressional Republicans have little more than a white paper to show voters what they would do if given the chance to repeal the health care law that bears his name.

Speaker Paul Ryan on Wednesday will lay out the House’s plan to repeal and replace Obamacare in a paper designed to show voters the GOP isn’t just a party of no.

But the paper — which paints a conservative health policy agenda in broad strokes but doesn’t get into details like dollar amounts, who would be covered or how much financial help they might get — underscores the political and policy problems facing Republicans as they seek to unite around a plan to unravel a social safety net program that is already used by 20 million people.

Conservative factions have blasted plans deemed to provide too much coverage — such as Scott Walker’s prescription when he was running for president — as “Obamacare Lite.” At the other end of the spectrum, moderate Republicans have criticized plans that offer too little coverage as unsympathetic to people with expensive pre-existing illnesses.

“If you live in the Republican conference … I don’t think Jesus could get everyone to agree on everything,” said Rep. Phil Roe (R-Tenn.), a physician who has attended all of the task force meetings on the health plan.

Ryan has framed the new paper as a starting point — a broad outline that the committees with jurisdiction would have to hammer out next year, if there is a GOP president who would sign off on a congressional repeal of Obamacare. There is some overlap with the vague plan laid out by presumptive Republican nominee Donald Trump on his campaign website.

The 37-page plan pledges to reduce consumers’ average health care premiums by double digits and bend the health care cost curve. But it does not lay out detailed answers about what it means to people who get coverage now.

“The hard part for Republicans is going to be the millions of people who did not have coverage before who now have coverage — how are you going to explain it to them?” said Bill Hoagland, a former senior Republican Senate policy staffer who is now at the Bipartisan Policy Center. “I think that’s going to be a difficult row to hoe.”

The GOP proposal starts with a transition period out of Obamacare and into a new plan. It would encourage people to have insurance coverage with the help of advanceable, refundable tax credits adjusted for age. It would encourage small group health plans and provide $25 billion in incentives to states to set up high-risk insurance pools — more funding than was available to failed state high-risk pools in the past, according to senior House Republican aides.

The tax benefit for employer sponsored insurance would be capped — at a high but undefined level according to an aide — to discourage plans that enable indiscriminate health care spending, offering an alternative to Obamacare’s Cadillac tax, which Congress has suspended.

In place of Obamacare’s individual mandate, the plan would prohibit insurance companies from denying patients coverage or charging them more because of pre-existing conditions — but only if they keep continuous insurance coverage, although they could switch plans or carriers. It would also allow young adults to stay on their parents’ health plans until age 26 — one of the most popular pieces of Obamacare.

Insurers would be allowed to sell across state lines and medical liability laws would be reformed. States would get block grants to administer Medicaid with caps on how much could be spent per person, with accommodations for high-cost patients. A premium support plan — similar to the one Ryan outlined several years ago when he was the House Budget Committee chairman — would be introduced to Medicare.

“Directionally, this could be promising,” said Gail Wilensky, who ran Medicare under former President George H.W. Bush. “I doubt that you’re going to have people now supportive of the ACA who say, I now want this instead. But it gives people who are not happy with the ACA — which is a lot — [reason to think] this may be promising.”

Ryan has always framed his policy task forces — health care is one of six — as starting points to inform voters of the direction a GOP-led Washington would head. A senior House Republican leadership aide compared this to the white paper released by former Senate Finance Committee Chairman Max Baucus in November 2008, “which did not have any numbers in terms of subsidies or tax increases either,” which eventually became the Affordable Care Act.

“It is laying the groundwork for what the Congress and House Republicans would do next year through the committee work to put specifics behind the legislative proposals,” the aide said.

While House Republicans have voted to repeal Obamacare dozens of times, a consensus GOP alternative to Obamacare has hamstrung Republicans since the legislation was signed in 2010. But many Republicans feel buoyed by the bad headlines that continue to plague the law which they see as reinforcing their view that the law is disastrous for patients and doctors and is way more costly than Obama promised.

“The things that we talked about six years ago are coming to fruition,” Roe said, pointing to insurers’ requests for double-digit rate increases while others flee the Obamacare markets altogether. “This is now conference-wide, a bill that we can hold up and say that if the American people entrust us with the White House and Congress, this is a framework of what we can give to the American people.”

Republicans have always known they were unlikely to unwind Obamacare until the president left office. They argue there was scant reason to release a plan with legislative text and other details until repeal was more realistic, given that it was certain to get hammered by Democrats.

But now that the prospect of a Republican president is within the realm of possibility, those conversations are becoming more serious.

Repeal of the health care law would be enormously difficult, even if Trump is elected. Putting aside the political battle, there are practical legislative roadblocks, too. There is no realistic scenario in which the GOP would have 60 votes in the Senate to approve legislation — a de facto firewall to prevent repeal of the health law in the immediate future.

Republicans last year did try to repeal several large parts of the law through the complex budget reconciliation process, which needs only 51 Senate votes. That measure was vetoed by Obama, but GOP leaders hope that with a Republican in the White House, repeal of major parts of the law could get approved.