House Speaker Paul Ryan, incoming Health and Human Services Secretary Tom Price and other top GOP leaders have kept up their barrage against the Affordable Care Act’s premium increases and reduced competition, even after their massively successful election last month.

“This law is hurting families in America,” Ryan said before Congress left Washington for the holidays.

“This law is canceling insurance plans people wanted, this law is giving people repeated double-digit premium increases, this law is raising deductibles so high it doesn’t even feel like you have insurance,” he said. “So you have to bring Obamacare relief as fast as we possibly can in 2017, and that is our plan.”

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Beginning in January, the Republican-controlled Congress, working with the incoming Trump administration, will have the opportunity to roll back the Affordable Care Act and replace it with a plan that is less driven by federal control and regulation. The starting point for this effort ought to be that everyone in the United States should have health insurance, protecting them against major medical expenses. To do so, the GOP should:

  • Grandfather Coverage Provided by the ACA
  • Accept and Clarify Medicaid’s Role as the Safety Net Health Insurance Program
  • Impose Cost-Discipline and Generate Revenue with an Upper Limit on the Tax Preference for Employer-Paid Premiums
  • Build an Effective Auto-Enrollment Program to Achieve Higher Levels of Coverage


Repealing Obamacare would free Americans to purchase more secure health insurance than either Obamacare or employers offer. Every day Congress waits, the problem of pre-existing conditions gets worse.

Congress should replace Obamacare as Mr. Trump pledged during the campaign.

Incredibly, some congressional Republicans are mulling a partial repeal—keeping the parts of Obamacare that supposedly protect sick patients, but instead make coverage worse and that are causing insurance markets to fall apart. There is even talk about keeping Obamacare’s billions of dollars in bailouts to insurance companies—including billions that a federal judge ruled unconstitutional—and using the money to replace Obamacare with Obamacare-lite.

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Health and Human Services Secretary-nominee Tom Price has a radical idea: Let Medicaid recipients choose their own health insurance plan just as millions of Americans do every year.

Both House Speaker Paul Ryan and Price want to replace Obamacare subsidies with refundable tax credits—which would essentially function like a federal subsidy—for people who do not have access to employer-provided health insurance, Medicare, Medicaid or VA coverage.

But under legislation introduced by Price in 2015 (see section 102), a person in a government-run program such as Medicaid could opt out and take the tax credit instead.

That’s exactly the right thing to do.

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The debate over the future of America’s health system is just beginning. Democrats are certain to use every opportunity to defend Obamacare as a success. So what better time to debunk some of the biggest misperceptions about health policy that liberals have been pushing for decades? Ridding our healthcare debate of these fallacies is vital to building a successful health sector from the ruins of Obamacare. Sally Pipes, President of the Pacific Research Institute, highlights myths such as: “Universal coverage should be the ultimate goal,” “Health care and health insurance are the same thing,” and “No one should ever have to pay out of pocket for health care.”

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Lanhee Chen, leading conservative health care expert, says, “There are a lot of people out there probably who assume that Republicans have no ideas on health care, because this has been the Democratic talking point for a long time. I think actually just the opposite is true. It’s not that we don’t have enough ideas as conservatives, it’s that we actually have too many. A lot of thinking and research has gone on the last several years around how you create a health care system that is more consumer friendly, that pays attention to costs first, that recognizes the importance of health care in people’s lives but doesn’t believe that the federal government is necessarily well-suited to make all of those important decisions.”

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Republicans have said they want to move quickly to craft a replacement plan after successfully repealing Obamacare. But it is not clear how they will pay for a key part of that replacement, tax credits to pay down health insurance.

Republicans have not released a replacement plan for repealing Obamacare. However, some Republicans have introduced legislative text that give a sense of the direction the GOP wants to go.

For instance, Rep. Tom Price, the Georgia Republican who President-elect Trump nominated to be secretary of the Department of Health and Human Services, has a plan. Price’s Empowering Patients First Act includes tax credits that are pegged by age instead of income so a person who is younger would get a smaller tax credit than someone older who presumably has higher healthcare costs.

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The Republicans are thinking of leaving Obamacare’s regulations in place because they fear that a bill altering them would die in a filibuster. They are sure they can use a procedure for avoiding filibusters if they target only the law’s tax and spending provisions.

This course could cause the insurance exchanges, already in trouble, to collapse entirely. That’s because the Republican bill would scrap the individual mandate while keeping Obamacare’s requirement that insurers treat sick and healthy people alike.

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House Republicans, responding to criticism that repealing the Affordable Care Act would leave millions without health insurance, said on Thursday that their goal in replacing President Obama’s health law was to guarantee “universal access” to health care and coverage, not necessarily to ensure that everyone actually has insurance.

“Our goal here is to make sure that everybody can buy coverage or find coverage if they choose to,” a House leadership aide told journalists on the condition of anonymity at a health care briefing organized by Republican leaders.

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Repealing Obamacare could take months and developing replacement health insurance plans could take years, senior Republican aides in the U.S. Congress said on Thursday, discouraging talk of a quick end to the program after President-elect Donald Trump takes office on Jan. 20.

“We are talking a matter of weeks, in two months – but not a matter of many months” for Congress to pass a repeal, one aide said, adding that Republicans “certainly” hope Trump will sign the repeal into law in the first half of 2017.

Congressional Republicans are consulting with the Trump transition team on when the effective date of the repeal should be, another aide said. Setting it a few years out will provide lawmakers time to debate whether and how to replace some elements of the Obamacare law.

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