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Today in Obamacare: a new ad says Republicans “have a plan.” Do they?

A new ad says “Republicans have a plan” to fix health care. That was news to me.

Earlier this week, astute observers noticed this American Action Networks ad turning up on cable news. It talks about a new health reform plan that provides “more choices and better care at lower costs” and “provides peace of mind to people with preexisting conditions.”

“House Republicans have a plan to get there without disrupting existing coverage,” the voiceover continues.

This ad was striking because Republicans seem far, far from settled on how exactly they’ll repeal and replace Obamacare.

An American Action Network spokesperson says the plan that this ad and others refer to is A Better Way, a health care proposal from House Speaker Paul Ryan (R-WI). This is one among many plans that legislators have proposed. It is true that that plan exists, but it also seems like a stretch to position A Better Way as a plan that Republicans have committed to as a political party.

But now that we know which plan this ad refers to, we can evaluate some of the claims made in the advertisement:

“More choices and better care at lower costs”: A Better Way would quite possibly create more health insurance choices, as it would eliminate many of the health law mandates. Insurers could create plans that, for example, would not have to cover the ACA’s 10 essential health benefit categories, which includes things like maternity care and mental health coverage.

These plans would likely be cheaper, too: Premiums would go down as insurance plans cover less. But these plans would not necessarily be “better” in the way we typically think of good health insurance. They would cover fewer benefits and possibly have much higher deductibles than the plans offered under the ACA. That could be better for healthy people who don’t want a lot of coverage, but a whole lot worse for people who are sicker or older and go to the doctor quite a lot — who would find that these plans are much worse.

“Provides peace of mind to people with preexisting conditions”: A Better Way restricts — but doesn’t entirely ban — insurers’ use of preexisting conditions in determining coverage. A Better Way, like Obamacare, requires insurance plans to offer coverage to all patients, regardless of how sick they are. But to be clear: This is not a repeal of preexisting conditions altogether. The Better Way plan would let insurers charge sick people more if they did not maintain "continuous coverage." You can read a fuller explanation of how that provision is different from current law here.

“Without disrupting existing coverage”: A Better Way would actually be quite disruptive to American health care — even for people who don’t get coverage through Obamacare. For example, the plan would cap the tax exclusion for employer-sponsored insurance, a change that could be quite disruptive for the 156 million Americans who get coverage at work. It would reduce Medicaid rolls by 18 million, shifting many of those people to private coverage — another disruption. And it would overhaul how the law’s tax credits work, giving everyone an equal subsidy rather than offering more support to the lowest-income Americans.

You can argue about whether these disruptions would be good or bad (both liberal and conservative economists, for example, think it’d be quite good to do away with the tax exclusion for employer-sponsored coverage), but it seems hard to make a case that there wouldn’t be major upheaval.

53 percent of Republicans don’t know that repealing Obamacare would end Medicaid expansion

Ezra Klein writes on a new New York Times poll:

The basic message of this poll — that there’s a lot of confusion around what the Affordable Care Act actually is and does — is consistent with past surveys. The Kaiser Family Foundation, for instance, polled Trump voters on the Affordable Care Act, and found the Medicaid expansion, Medicare taxes, and out-of-pocket limits are popular even among Trump supporters.

You should read Ezra’s piece (as well as the original story from Kyle Dropp and Brendan Nyhan). The only thing I’d add is that in a lot of ways, this is a problem of Democrats’ own making. Because the health care law started off pretty polarizing and unpopular, Democrats were skittish about advertising the coverage expansion as Obamacare.

“We wanted to get as far away from the word ‘Obamacare’ as we could,” former Kentucky Gov. Steve Beshear, a Democrat, told me recently of how they messaged the law in his home state. “Polls at that time in Kentucky showed that Obamacare, that was disapproved of by maybe 60 percent of the people.”

That decision, this New York Times poll suggests, has consequences: Democrats didn’t talk about the fact that these new insurance programs were Obamacare — and now, a few years later, a lot of people don’t know these new programs are Obamacare.

Kliff’s Notes: Today’s top three health policy reads

“A Senate staffer who helped shape Obamacare answers our readers’ questions”: “If anyone truly understands the Affordable Care Act, it is John McDonough. He was a key Senate staffer in Sen. Ted Kennedy’s office during the health care debate in 2009 and 2010, and had a front-row seat to how the 1,300-page bill came together. He even wrote an entire book about the experience, called Inside National Health Reform.” —Lauren Katz, Vox

“GOP Senator on Obamacare replacement: ‘There’s Not Any Real Discussion Taking Place Right Now”: “It was a rare public admission of what has become obvious from the outside, as Republicans find both the politics and the substance of Obamacare repeal more difficult in practice than in rhetoric. ‘To be honest, there’s not any real discussion taking place right now,’ Corker told reporters in the Capitol.” —Ryan Grim and Jeffrey Young, the Huffington Post

“The GOP's growing problem of how to pay for Obamacare replacement”: “Now, powerful lobbyists are trying to knock out another big source of money: the GOP plan to limit the tax break for employer health coverage. If both funding sources go, there's not much money left for an Obamacare replacement.” —Caitlin Owens, Axios