The House GOP today released the final of their six major policy blueprints that they will be running on in 2016 and passing in 2017.
Today’s iteration is in many ways the touchstone of the whole effort: tax reform. The plan is, as the report boldly proclaims, “Built for Growth.” But it wisely does so in a way that doesn’t forget middle class working families struggling to get by, and in a way that passes a basic test of common sense and practicality.
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Paul Ryan has gotten his often fractious House Republicans to endorse an outline of a plan to replace Obamacare, although not yet an actual piece of legislation. While the outline contains many of the health policies conservatives sought even before Obamacare, those policies may have particular appeal against the backdrop of the health-care system Obamacare has created.
In the past Republicans have argued about how to reform tax policy on health care: Should employer-provided coverage remain untaxed, or should this tax break end? Should people without access to such coverage get a tax credit or a tax deduction? The House plan lets the tax break stay — avoiding the political disaster that a less compromising free-market plan would have courted — but trims it for the most expensive plans.
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House Republicans have estimates from the Congressional Budget Office on how their health care plan, released Wednesday, would affect the federal deficit. They’re just not releasing them.
The 37-page white paper doesn’t include cost and savings estimates, according to a senior GOP aide, because Republicans may want to break up the plan into smaller bills and some of the numbers depend on major decisions yet to be made.
Health analysts say there’s another reason for not offering estimates — it keeps Republicans from publicly making tough decisions about tradeoffs between cost savings and coverage. These decisions could open them up to harsh criticism from Democrats and would likely divide members of the GOP caucus itself.
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Is the new House Republican plan to replace Obamacare politically viable? Two factors weigh in the plan’s favor: First, after the administration sold Obamacare as a program for middle-class families who were anxious about losing their coverage if something went wrong, Democrats delivered a plan that made a lot of middle-class families worse off, and few of them better off. Second, the continuing problems in the insurance exchanges mean we remain at risk of seeing the number of uninsured start to march back upward, as unsubsidized consumers start to drop their high-priced, high-deductible, narrow-network insurance.
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Today, after years of hearings and speeches and debates, the Paul Ryan-led House of Representatives has done something it has not done before: it has released a comprehensive, 37-page proposal to reform nearly every federal health care program, including Medicare, Medicaid, and Obamacare. No proposal is perfect—and we’ll get to the Ryan plan’s imperfections—but, all in all, we would have a far better health care system with the Ryan plan than we do today.
The first thing to know about the Ryan-led plan — part of a group of proposals called “A Better Way” — is that it’s not a bill written in legislative language. Nor is it a plan that has been endorsed by every House Republican.
Instead, it’s a 37-page white paper which describes, in a fair amount of detail, a kind of “conversation starter” that House GOP leadership hopes to have with its rank-and-file members, and with the public, in order to consolidate support around a more market-based approach to health reform.
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House Speaker Paul Ryan’s policy plan for health care, as expected, leans heavily on market forces, more so than the current system created by Obamacare. The proposal contains a host of previously proposed Republican ideas on health care, many of which are designed to drive people to private insurance markets.
Importantly for conservatives, as part of a full repeal of the Affordable Care Act, the current law’s mandates for individuals and insurers would disappear under the GOP plan. It would overhaul Medicare by transitioning to a premium support system under which beneficiaries would receive a set amount to pay for coverage. The plan also would alter Medicaid by implementing either per capita caps or block grants, based on a state’s preference.
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A House Republican alternative to Obamacare is coming this week, and some reports suggest it will include a refundable tax credit to subsidize health insurance. This would present some tough political and policy choices about whether and how to pay for a new program of tax credits.
Changing the tax treatment of employer-provided health insurance could provide one of the largest potential sources of financing for a new refundable credit. It also would bring hefty trade-offs. On the political side, capping the deductibility of employer-based health plans to finance refundable credits that are considered government spending would not please some Republicans. Put another way: Repealing Obamacare’s tax increases to replace them with other revenue increases is unlikely to go over well with conservative voters.
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Donald Trump’s inconsistencies on health policy are baffling experts and deepening the doubts that conservatives have about his candidacy.
The presumptive Republican presidential nominee has put forward a healthcare plan on his campaign website that leaves out many of the bolder promises he has made during debates and speeches.
Trump has repeatedly promised to “take care of everybody,” but his health plan includes no major expansion of coverage; one analysis asserted the proposal would actually end coverage for 21 million people.
Similarly, he has vowed to keep protections for people with pre-existing conditions, but his plan includes no such provision.
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Republican lawmakers crafting alternatives to Obamacare face a fundamental decision: whether to focus on expanding coverage or containing costs. Their choice may be driven, at least in part, by budget scorekeepers.
The Congressional Budget Office released a report in December 2008 on key issues in analyzing major health-care proposals. Included was a chart projecting individuals’ willingness to enroll in health insurance at various levels of subsidy (in technical terms, an elasticity curve). That curve suggested that insurance enrollment would remain below 40% until subsidies reached 70% of cost and that even if costs were 100% subsidized, about a fifth of individuals would decline to enroll. (And that level of subsidy is probably much greater than many Republicans would be willing to offer.)
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