If there’s one thing Republicans have been clear about for the past six years, it is that the top of their agenda includes repealing Obamacare.
But Obamacare repeal would leave 22 million Americans without coverage and wreak havoc on the individual insurance market. It’s becoming increasingly clear that Republicans can’t just repeal Obamacare — they need to replace it with something.
There are at least seven different replacement plans that Republican legislators and conservative think tanks have offered in recent years. I’ve spent the past week reading them, and this is a quick summary of what I learned (you can read a longer version here).
Yes, Republicans have replacement plans
It is true that the party has not coalesced around one plan — but there are real policy proposals coming from Republican legislators and conservative think tanks. There are two plans I think are most important to know about:
- Better Way, a proposal from House Speaker Paul Ryan, would overhaul the individual market and Medicaid in a way that would generally benefit healthy, young people and disadvantage older, sick people.
- The Patient CARE Act, from the Senate Finance Committee, is similar to Better Way but focuses more on helping low-income people.
Other plans that exist and could come into the debate include:
- Two plans introduced as legislation in Congress: one from Rep. Tom Price (R-GA), who is in the running to become Trump’s health and human services secretary, and one from Sen. Ted Cruz (R-TX)
- Two plans from conservative think tanks, the American Enterprise Institute and the Foundation for Research on Equal Opportunity
- A bare-bones plan from President-Elect Donald Trump
There is significant variation in what the plans propose
On one end of the spectrum, you see plans from Trump and Cruz that would repeal Obamacare and replace it with virtually nothing. On the other end, there are plans from conservative think tanks that go as far as to keep the Affordable Care Act marketplaces and continue to give low-income Americans the most generous insurance subsidies.
If we can say one thing about most Republican plans, it is this: They are better for younger, healthy people and worse for older, sicker people
In general, conservative replacement plans offer less financial help to those who would use a lot of insurance. This will make their insurance subsidies significantly less expensive than Obamacare’s — but could hurt people who have high medical costs.
Most Republican plans don’t eliminate preexisting conditions
These plans generally require insurers to offer coverage to everyone, but they do not stop insurers from charging people more because they are sick. Those who have a break in coverage can face high premiums tethered to their health status.
Economic analyses estimate that these plans will reduce the number of Americans with insurance coverage
The actual amount varies significantly, from 3 million to 21 million, depending on the plan. They will near certainly provide more coverage than Americans had before Obamacare, but also less than what exists currently.
There are tens of millions of Americans who rely on the Affordable Care Act for health insurance coverage — who aren’t quite sure what the 2016 election, and Republicans’ promises of repeal, mean for them.
We’ve launched a Facebook group for those people to talk about their shared experience. We want this to be a place where Vox readers in this situation can share their stories. From time to time, we’ll ask this group questions about their experiences — some of which might lead to stories. If you’d like to request to join the community, use this link.