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Today in Obamacare: the one question Republican senators really don't want to answer

Senate Lawmakers Address The Media After Their Weekly Policy Meetings Photo by Chip Somodevilla/Getty Images

Welcome to Today in Obamacare, Vox’s regular update on the battle over the Affordable Care Act, the changes a new president and new Congress might make, and what it means for the American people. Have a story you think should be here? Send me an email at sarah@vox.com.

Will Republicans’ replacement plan cover as many people as Obamacare? ¯\_(ツ)_/¯ I spent Tuesday on Capitol Hill, talking to Senate Republicans about whether they expected their replacement plans to cover as many people as the Affordable Care Act. The answers were ... not plentiful.

I put the question to Sen. Cory Gardner (R-CO), who told me, “We’ve got to have a plan that is better than Obamacare. Obamacare has failed on its initial goals, the promises that were made, so I look forward to having a plan in place that will actually work for the American people.” I repeated the question about coverage specifically, at which point he turned around and walked away.

Sen. Tim Scott (R-SC) told me this: “You know what I think. That’s a complicated question for me to answer. I think if you look at where we were before Obamacare, 85 percent, we’re at 91 percent now. So 6 percent is 18 to 20 million people. The question is how do you create access without it being federal government–centric? Which I think we can make sure it’s accessible to folks; then they can make their own decisions.”

When I repeated the question, whether those 18 to 20 million people would have coverage under a Republican replacement, he said, “Depends on the definition of when they have coverage. They will have the opportunity to make a decision for coverage.”

This wasn’t just me. Bloomberg’s Sahil Kapur seems to have had a similar experience talking to Republican legislators in the House. "Look, I’m not going to get ahead of our committee process," House Speaker Paul Ryan told reporters, including Kapur, Thursday when asked if he could guarantee a GOP replacement would cover as many people as the Affordable Care Act. "We’re just beginning to put this together."

You should definitely read Kapur’s article here.

What’s next on Obamacare? Nobody really knows My colleague Jeff Stein has been with me on Capitol Hill today, and caught up with Sen. Lamar Alexander (R-TN), who has voiced concerns about moving forward on repeal without a replacement. Except when Jeff talked to him, the concerns weren’t quite as pronounced. Jeff asked him whether the party should wait for a replacement plan before moving forward on repeal. Here’s what he said:

“No, I think it's important to start the process. Our goal should be to make sure we replace Obamacare with practical, concrete alternatives that give Americans better access to truly affordable health care, to do that carefully, and to do that step by step.”

If anything, Jeff’s exchange with Alexander illustrates to me how fluid the situation is on the health care law. You have Republican senators who have expressed reservations about voting for repeal and delay — but who are still open to voting for repeal without a replacement. Much like the Democrats’ health care in law in 2009, Republicans’ repeal efforts may be declared dead many times over the next few months, only to rise from the ashes.

Donald Trump wants a replacement plan to be “simultaneous” or within “weeks.” Here’s one he could use. Trump told the New York Times Tuesday that he wants the repeal and replacement of Obamacare to be “simultaneous,” a very different approach than the repeal-and-delay strategy that congressional Republicans have focused on. “Long to me would be weeks,” Trump told the Times. “It won’t be repeal and then two years later go in with another plan.”

If Trump is serious about pursuing replacement quickly, then there is one plan he could pull off the shelf — and it was written by none other than his pick to run the Department of Health and Human Services, Rep. Tom Price (R-GA). Price is the author of the most detailed Obamacare replacement I’ve read to date, the 242-page Empowering Patients First Act.

If you’re looking for a replacement plan that isn’t just a white paper — that actually exists in legislative language — this is it. And given that sounds like what Trump is looking for right now, it’s worth going over how the Empowering Patients plan works:

  • Empowering Patients restricts — but doesn’t ban — discriminating against people with preexisting conditions. Price’s Empowering Patients plan, like Obamacare, requires insurance plans to offer coverage to all patients regardless of how sick they are. But the Empowering Patients plan, unlike Obamacare, would let insurers charge sick people more if they did not maintain “continuous coverage.” This means that someone who has a break in coverage could face higher, possibly unaffordable insurance rates — although the Price bill does cap premiums for the sick at 150 percent of the regular rate.
  • Empowering Patients makes insurance better for people who are young and healthy. It makes insurance worse for people who are old and sick. There are a lot of elements of the Price plan that create new winners and losers. One is that Empowering Patients eliminates Obamacare’s set of “10 essential benefits,” which mandates that all insurers cover a set of 10 different types of care, including maternity services and pediatric care. This is great if you’re healthy (fewer benefits means lower premiums) but crummy if you actually need medical care.

Price would provide tax credits, but they would help the poor and young less and older and richer people more. Obamacare’s tax credits are based on income, with people who earn less getting more help. Empowering Patients’ tax credits would only be based on age, giving more help to those who are older (and who will presumably be charged higher premiums). This means that Bill Gates would qualify for the largest tax credit simply because he is 61 years old. Under the Empowering Patients bill, Gates’s net worth of $83 billion — presumably enough to purchase health coverage — would do nothing to disqualify him. Under Obamacare, he gets no help. Conversely, a 23-year-old with little income and health problems gets minimal help under Price’s plan — despite the fact that he needs support much more than Gates does.

Price’s plan is the most thorough plan that exists right now — but it’s also important to keep in mind that it hasn’t faced any votes in Congress, let alone any committee hearings. It is far from vetted by the Republican Party, but if quick replacement is the goal, then this bill likely provides the best shot.

You can read a more thorough explanation of the Price bill here.

Kliff’s Notes: today’s three health care reads


Watch: Repealing Obamacare could change millions of lives

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