WASHINGTON — Repealing the Medicaid expansion, defunding Planned Parenthood and a ban on federal tax credits paying for abortions are among the measures contained in a draft House Republican Obamacare repeal plan obtained by Politico.
Speaker Paul Ryan is expected to unveil the final plan this week. But a draft plan posted online by Politico would repeal all of the main planks of the Affordable Care Act and replace them with a system of tax credits and softer incentives.
The plan would repeal the individual and employer mandate. Instead it would push people towards buying insurance by shielding them from steep price increases as long as they don't let their coverage lapse.
The plan would cut funding to Planned Parenthood, setting up a major battle in the Senate.
Perhaps just as contentious will be the repeal of Medicaid expansion as of January 1, 2020. This will be hard to sell politically because it means ending billions of dollars in subsidies to the states, including 18 states with Republican governors. States can choose to continue covering these enrollees if they so choose.
This would in part be offset by $100 billion in "state innovation" grants over nine years to go towards taking care of higher-cost patients.
Obamacare subsidies are replaced with a tax credit that is based on age. A 20-year-old will receive $2,000 per year to put towards health expenditures, a 30-year-old will receive $2,500 and so on up to a $4,000 credit for everyone 60 and older.
These tax credits cannot be put toward paying for abortions or even any health insurance plan that offers coverage for abortions. Past versions of this plan have sparked allegations that the IRS will have to conduct "abortion audits" to make sure they qualify for federal funding under grounds such as rape and incest.
Essential health benefits mandated under the ACA would be repealed as of 2020. This would allow insurers to offer cheaper plans with less comprehensive coverage.
Many of the taxes of Obamacare would be repealed. Programs to prop up the individual insurance markets created under the ACA, such as the cost sharing subsidy, would also be repealed.
The plan also calls for a cap on Medicaid payments. Currently Medicaid is an entitlement program that is paid out to anyone who qualifies. Under the House plan, federal expenses would be capped at a set amount and the states would have to figure out the rest. The cap will be calculated based on 2016 payouts plus healthcare inflation.
Once announced, this will be the third Republican ACA repeal plan before Congress. An alternate plan from Sen. Rand Paul would essentially strip away Obamacare with a similar tax credit system but less generous grants than the House Republican plan.
The third is the so-called Cassidy-Collins plan put forward by a group of Republican senators including Bill Cassidy and Susan Collins. Their plan was pitched as a compromise proposal because it would preserve the most popular parts of Obamacare, such as the ban on denying coverage to people with pre-existing conditions, and let states elect to keep the existing ACA system if they like it. However, it would preserve the costs to the federal government of the Medicaid expansion, which many Republicans have vowed to claw back.