A new Republican health care plan keeps much of the basic framework set up by Obamacare, but with a conservative twist, analysts say.
But it’s full of holes, with no detail on how to pay for its provisions and no estimates at all of how much it will cost taxpayers.
While conservatives praised the emphasis on personal responsibility, liberals said it would take newly won health insurance away from millions and cost people protection from some of the worst abuses of the insurance industry.
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And it’s not even clear if all Republicans in Congress will vote for it. At best, analysts agreed, it’s a work in progress.
“I think their basic overriding philosophy is to let the states decide a lot of things, which is sensible,” said economist Douglas Holtz-Eakin, president of the American Action Forum and a former director of the Congressional Budget Office.
Moments after the House Energy and Commerce and Ways and Means committees unveiled their plans on Monday, Michigan Republican Rep. Justin Amash called it “Obamacare 2.0” on Twitter.
Kentucky Senator Rand Paul, another Republican, called it “Obamacare Lite.”
Senator Rand Paul Tweet : Still have not seen an official version of the House Obamacare replacement bill, but from media reports this sure looks like Obamacare Lite!
“What they kind of have is a repeal plus,” said healthcare expert Joe Antos of the American Enterprise Institute, who’s done stints in the Congressional Budget Office and the Health and Human Services Department.
“This is a kind of a hodge podge and I don’t see it’s much different from what we saw a few weeks ago,” Antos told NBC News.
The plan stops the unpopular mandate that required almost everyone to have some sort of health insurance. It replaces that by allowing health insurance companies to charge 30 percent higher premiums if customers had gone 63 days or more without health insurance.
Both provisions were meant to prevent people from waiting to buy health insurance until they were sick.
“That could encourage some healthy people to sign up initially,” said Larry Levitt, a health policy expert at the nonpartisan Kaiser Family Foundation.
The 2010 Affordable Care Act required health insurance companies to cover anyone who wanted to buy insurance, and is laid out a minimum list of conditions that had to be covered or services provided, from pregnancy care to cancer screenings.
It stopped a once-common practice of capping coverage once a customer started costing too much, and aimed to limit bare-bones plans that covered almost nothing.
Many of these appear to be preserved in the new plans, at least for a time, along with another popular provision that allowed young adults to stay on their parents’ plans until they turned 26.
Justin Amash Tweet : Obamacare 2.0
The new American Health Care Act would allow health insurance companies to charge older people five times as much as they charge younger clients — the current limit is three times as much.
Taxes that paid for the old Obamacare subsidies, which helps an estimated 85 percent of people who bought private health insurance on the exchanges, are gone. Instead of subsidies, the plan provides tax credits for people making less than $75,000 a year.
There are few details on how the Republicans plan to pay for the tax credits, however.
“I don’t understand where the money comes from. I understand what they have taken away,” said Republican health economist Gail Wilensky, who now is a senior fellow at Project HOPE. “It’s just a mystery.”
Ron Pollack, executive director of Families USA, a strong supporter of Obamacare, said it will return many Americans to pre-Obamacare days.
“This bill would strip coverage from millions of people and drive up consumer costs. It shreds the Medicaid social safety net that serves more than 72 million people, including many children, senior citizens and people with disabilities,” said Pollack. “And it once again leaves millions of people in America with chronic illness and disease at the mercy of insurance companies.”
House Democratic leader Nancy Pelosi of California called it a “Make America Sick Again” bill.
“Republicans even enable insurers to once again charge more or deny coverage to millions of Americans with pre-existing conditions, abandoning those families who lapse in coverage for any reason at all,” she said
House Energy and Commerce Committee Ranking Member Frank Pallone, Jr., a New Jersey Democrat, and Ways and Means Committee Ranking Member Richard Neal of Massachusetts said they could would not support the plan.
Larry Levitt Tweet: The GOP’s tax credits provide substantially less help than the ACA for low-income people, who were most likely to be uninsured pre-ACA.
“The Republican repeal bill would rip health care away from millions of Americans, ration care for working families and seniors, and put insurance companies back in charge of health care decisions — contrary to everything President Trump has said he would do with his health care plan,” they said in a joint statement.
The plan sets out a path to revising Medicaid, the joint state-federal health plan for low income people. It allows the 31 states plus Washington D.C. that expanded Medicaid under the Affordable Care Act to keep getting federal funding to do that but inexplicably leaves out the 19 most Republican states that refused to take part.
Instead, those states will get cash. It’s not enough, said Wilensky. “I don’t think $10 billion is enough,” she said.
Baltimore City Health Commissioner Dr. Leana Wen says the changes to Medicaid will eventually leave many people out in the cold. “Medicaid provides the ultimate safety net for individuals who need it the most. I am extremely concerned about that,” she said.
The ACA was designed to get health insurance to more Americans, and it did. At least 20 million more people have health insurance than before the law was enacted, about half of them on new exchanges set up to help people buy private health insurance, often with federal subsidies, and about half through an expansion of Medicaid.
In 2010, the year the law was signed, 48.6 million Americans or 16 percent of the population had no health insurance. The ACA brought that to below 9 percent.
Republicans are wary of making changes that will take health insurance away from millions of Americans, but are under pressure to make the reforms look more like a return to private industry, with less government oversight.
Chuck Schumer Tweet: Trumpcare doesn’t replace the Affordable Care Act – it forces millions of Americans to pay more for less care.
Antos said the plan may compromise too much.
“Some Republicans will say, ‘No, you’ve gone too far (and) give things away’ and other Republicans will say, especially in the Senate, ‘you haven’t gone far enough to say what you are going to replace it with’,” he said.
“So it seems like there’s a sweet spot here, but it’s not a sweet spot that a politician would want to be in.”