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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.
Let’s explore some Republican health policy plans — One of the biggest shifts this week — driven largely by President-elect Donald Trump and a handful of Republican senators — is one away from “repeal and delay” and toward “repeal and replace.”
That means now is as good a time as any to contemplate what replacement might look like. I’ve already written up a lot of Republican plans here, but there are some new ones in the mix that are worth taking a look at.
- Sen. Lamar Alexander might leave those with tax credits in a lurch. On the Senate floor this week, Sen. Lamar Alexander (R-TN) released his three-point replacement plan — although calling this a plan is a bit of a stretch, given that it’s just four paragraphs. Alexander’s plan suggests, like other Republican replacement plans, getting rid of the law’s essential health benefits (like maternity care or prescription drugs) and giving insurers more flexibility around what they do and don’t cover. One surprising part of Alexander’s plan is that it will “eventually provide tax credits to help lower income Americans buy insurance” — suggesting those tax credits would not be available to start.
- Sen. Bill Cassidy’s plan would allow the insurance markets to remain intact. Sen. Bill Cassidy’s (R-LA) Obamacare replacement bill continues to be one of the more interesting and surprising Republican offerings. It would allow states to automatically enroll uninsured people into low-cost health plans — a replacement for the individual mandate that would put the onus on the patient to opt out of coverage. Cassidy would also allow states that currently operate marketplaces to keep doing so, holding over a big element of the health care law. “I am almost agnostic as to what elements of Obamacare are in our plan or not,” he told me when we spoke last.
- Rep. Phil Roe wants to give everyone the exact same health care deduction — Something notable about most Obamacare replacement plans offered by Republican congressional leadership, unlike the one from Rep. Phil Roe (R-TN) is that they maintain certain pillars of Obamacare, like tax credits to buy insurance or a mechanism to encourage people to buy coverage. They each make big changes to those policies, but at the end of the day, a recognizable version survives.
Roe’s policy, championed by the very conservative Republican Study Committee is different. It includes no tax credits for the individual market and instead envisions giving every American, regardless of where they buy coverage, a standard deduction to offset the costs: $7,500 for individuals and $20,500 for families. Unlike Obamacare and some other Republican policies, these deductions wouldn’t get bigger for older people who typically have to spend more on insurance. They’d be the same for everybody — in that regard, it’s a huge shift from current policy.
One Democrat down, seven Democrats to go — Sen. Joe Manchin (D-WV) has expressed some openness toward working with Republicans on an Obamacare replacement plan. Earlier today, Politico reported that “Manchin has told GOP leaders that he's ‘happy to sit down with you to see if we can find a pathway forward.’” But openness toward working with Republicans is still a far cry from actually voting with Republicans — a lesson that senators like moderate Republican Olympia Snow taught us during the original health law debate.
Kliff’s Notes: today’s top three health care reads
- “We Asked People What They Know About Obamacare. See If You Know The Answers.” “About half believed that the number of people without insurance had increased or stayed the same, or said they didn't know what the law's effect has been on insurance coverage.”
- “Trump’s Obamacare impatience challenges the GOP”: “A quick repeal and replace of Obamacare on the scale the president-elect outlined is complex and arduous — and politically rife for accusations that Republicans are recklessly repealing a law with scant time for debate.”
- “Health Care’s Bipartisan Problem: The Sick Are Expensive and Someone Has to Pay”: “Congress has begun the work of replacing the Affordable Care Act, and that means lawmakers will soon face the thorny dilemma that confronts every effort to overhaul health insurance: Sick people are expensive to cover, and someone has to pay.”
