Lost in this past week’s news of fires, floods and the excesses and shortcomings of Donald Trump, was the release of the Republican Party’s leadership’s proposed health care plan for Americans, a plan the GOP would use to replace the Affordable Care Act.
Republicans have roundly criticized the ACA since its inception in 2008, but this is the first time they have proposed a mostly complete plan of their own. As would be expected, there’s an emphasis on more competitive coverage by insurance companies, and states would play a larger role. So, too, is there some additional personal responsibility.
A major component is that insurance coverage would not be mandated, as it is under Obamacare.
But at the same time, the realities of health care costs are clear to Republicans. Beginning in 2020, enrollment in Medicare would climb from today’s age of 65 to 67. Employees would also be taxed on their employer’s portion of their health insurance premium, something that does not exist in Obamacare. That quickly brought howls of protest from corporate associations, claiming that would discourage employees from signing up for insurance and thus weaken company-provided plans.
So-called Cadillac plans, which deliver extensive coverage, would be taxed. But Republicans would tax only the most generous plans, a higher level than the level included – and which has been postponed – in the Affordable Care Act.
Coverage for those with pre-existing conditions, a popular feature of the ACA, is in the Republican plan, but only if the insured maintain their coverage continuously. A break in coverage of two or three years would permit insurance companies to charge market premium rates.
Premiums could also be somewhat higher than allowed now for higher age individuals, reflecting their greater need for health care. That, in theory, would allow premiums for younger, healthier individuals to be lower.
But it is Medicaid, fast-growing and costly for the federal government and the states, that would see the greatest constrictions under the Republican plan.
States would receive lump sums for Medicaid coverage, which would encourage them to better manage costs; states also would be able to apply enrollment caps and waiting lists for enrollment. States could also require Medicaid recipients (which is now 1 person in 5 in Colorado) to pay some premium amount, and they could require that recipients are employed to some degree.
Health insurance accounts, talked about in recent years and in place for some, are in the plan. So, too, is the ability to purchase insurance across state lines. Nothing imaginative about those components.
As critics point out, financial analyses of the Republican plan are so far lacking. The parts are there, but the numbers are thin.
We praise the party’s proposal for recognizing the cost of health care and doing something, a few things, to address it. Increasing the age for Medicare is important, and shaping Medicaid to better involve the states in managing costs could be helpful. So, too, are the steps that will raise additional federal tax revenues.
As we have said previously, the Affordable Care broke a long-standing system of acquiring health insurance that was not working for many people. Too many were left out, and too many were financially defeated by health care costs. Whether some of what Republicans have proposed has value and can be added to the post-2008 direction this country takes remains to be seen. Health care costs are a critical challenge.
