House Republicans will unveil a health plan Wednesday that has been six years in the making, calling for an end to the heavy mandates and government-run exchanges of Obamacare in favor of incentives designed to entice customers into private-market plans.
The plan also embraces longtime Republican favorites such as allowing insurance companies to sell policies across state lines — a key part of the health care proposal from Donald Trump, the party’s presumptive presidential nominee — and calls for high-risk pools to provide coverage for sick Americans who are priced out of the private market.
The crux of the proposal is a tax credit intended to help offset the costs of insurance for those who don’t receive coverage through their employers or government programs.
Spearheaded by House Speaker Paul D. Ryan of Wisconsin, the proposal is an election-year blueprint rather than a bill.
Many of the details will remain vague because Republicans won’t bring the proposal to the floor for a vote and the Congressional Budget Office can’t score it. It’s unclear whether the plan would provide coverage to as many Americans as President Obama’s Affordable Care Act or what the cost to taxpayers would be.
Yet it is a significant milestone for a party that has struggled with the second half of its repeal-and-replace strategy on Obamacare, as long as its namesake wields a veto from the White House.
House Republicans have taken dozens of votes to repeal all or part of Mr. Obama’s signature 2010 reforms since taking the majority in 2011, yet they have failed to unify around a viable alternative despite a handful of plans that overlap in places.
“Today we are proposing a new approach. This report is the beginning of the conversation, not the end,” the plan says. “In contrast to Obamacare, our plan will serve as the foundation for multiple pieces of straightforward legislation, not a comprehensive, overly complex, and confusing 3,000 page bill.”
Premiums on Obamacare’s web-based exchanges are expected to rise next year, handing Republicans more ammunition to convince voters that the health care act is raising costs, offering subsidies that discourage work and imposing mandates that slash part-time jobs.
Their argument has been overshadowed by Mr. Trump’s blunt positions on illegal immigration and his proposal to ban Muslims from entering the U.S. until the federal government can better control the threat of Islamic terrorism.
“So far, Trump has been kind of erratic on health care policy and has not given us a really strong sense of what he would do,” said Lanhee J. Chen, a fellow at Stanford University’s Hoover Institution and adviser to Mitt Romney’s 2012 presidential campaign. “I think as a result, a lot of conservatives have been apprehensive about supporting or saying nice things about Trump. I would hope that Trump would simply take the [House Republican] plan and use it.”
The plan does keep parts of Obamacare in place, including letting young adults stay on their parents’ plans until age 26. It also prohibits denial of coverage to people with preexisting medical conditions.
Yet Republicans envision a one-time open enrollment period for uninsured Americans, regardless of how sick they are. They would receive a refundable tax credit large enough to purchase the typical pre-2010 plan.
Rather than Obamacare’s income-based system, it would be age-adjusted so that older Americans receive more support.
Consumers whose premiums are lower than the credit may use the balance to pay out-of-pocket costs or pad health savings accounts — tax-advantaged funds that encourage savings for medical expenses.
Among other limits, the plan would keep older consumers from having to pay more than five times the premium of a younger person, a return to the pre-2010 standard in place of Obamacare’s 3-1 ratio.
“The ill-advised 3-1 policy is leading to artificially higher premiums for millions of Americans, especially younger and healthier patients,” the plan says.
The plan also delves into Medicare, the government insurance program for Americans 65 and older. Starting in 2024, seniors could enroll in traditional Medicare or choose from competing private plans while receiving premium support from the federal government.
House Republicans and Mr. Trump have clashed over changes to Medicare. The Trump campaign did not return an emailed request for comment on the plan before its formal release.
Meanwhile, presumptive Democratic presidential nominee Hillary Clinton says she will build on Obamacare’s reforms, and House Democrats vowed Tuesday to defend Mr. Obama’s health care legacy.
Democrats said it was about time that Republicans came up with a plan of their own, though they criticized its lack of granular detail and said Obamacare and its historic gains in health care coverage are here to stay.
A senior House Republican aide said it is not unusual to leave the finer points of a plan to relevant House committees, much as Democrats did in the period between Mr. Obama’s election in late 2008 and Obamacare’s passage in March 2010.
“This plan is not the final piece of the puzzle,” the blueprint says. “This overall plan, and the policy solutions within it, is part of a larger conversation with the American people about what their health care needs truly are.”
• Tom Howell Jr. can be reached at thowell@washingtontimes.com.
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