Republican ACA Alternative = A Step Backwards 

By Rosana Garcia


On June 22, House Republicans in Washington, DC, released a plan to repeal and replace “Obamacare.”  As is common with proposals that come from Speaker Paul Ryan, the proposal is thin on specific numbers, and big on broad strokes.

Many of the policy concepts for an Affordable Care Act replacement are recycled ideas from previous Republican attempts at health reform.  Without concrete numbers, it makes it near-impossible to analyze the financial impact of these proposals.  What we can take a closer look at is the potential impact of this proposal.

Republicans have been talking about “repeal and replace” for the ACA since the health law was passed in 2010.  Last week’s plan is the first Republican policy proposal to detail a framework for replacing the ACA

The Republican “replacement” plan takes major steps backward from where we are today, six years into a post-ACA world.  For example, under the Republican plan:

  • Premium subsidies would still exist – but only based on age, not income or where someone lives.  That means that instead of looking at how much a person makes and how expensive health insurance is where they live, the Republican plan would give everyone of the same age the same subsidy.  A step backwards…
  • States will be forced to choose between a block grant for Medicaid, or a per capita cap for each enrollee.  In a block grant, federal funding would be limited to a certain amount of money for the whole state.  Per capita caps mean that each person on Medicaid will be limited to a certain amount of money for medical care.  In Connecticut, this may mean low-income individuals and families will lose HUSKY coverage.  A step backwards…
  • People would be able to buy health insurance across state lines, which would mean that states that impose regulations and strong consumer protections on their plans would be competing with plans in states that  moneyed insurance companies to reap profit rather than provide quality health care.  A step backwards…
  • High deductible plans would be encouraged – and we already know that big out-of-pocket expenses cause people to delay care due to cost.  A step backwards…

Overall, the Republican plan hurts consumers.  Instead of focusing on solving the continued problems of health care in our country, the Republicans would rather get rid of important steps forward made possible by the ACA.

The Affordable Care Act made important steps forward.  It expanded coverage options, provided subsidies to help people buy health insurance on the individual market, banned the practice of denying coverage for a pre-existing condition – and much more.  While the ACA is not perfect, and did not fix all problems in our complex health care system, it is a sound foundation from which to continue to improve health and health care across the country.

Instead of fighting the same fights, it’s time to take what now exists and make it better.  We must work toward a system that includes all of us, where we can get the care we need, when we need it, whether we can afford it or not.


House Republican Health Care Policy Proposal (June 22, 2016)

House Republican Health Plan Seriously Flawed – Center on Budget & Policy Priorities Statement from President Robert Greenstein (June 22, 2016)

Speaker Ryan’s Expected Health Care Plan Cuts Coverage for Millions and Ends Protections for People with Pre-Existing ConditionsFamilies USA Press Release (June 21, 2016)

The House Republicans’ Health PlanHealth Affairs, Joseph Antos & James Capretta (June 22, 2016)

House Republicans Unveil Long-Awaited Replacement for Health LawNew York Times, Robert Pear (June 22, 2016)


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