Republicans have put forth seven plans to replace the Affordable Care Act, as well as 67 pieces of legislation in Congress to dismantle the law despite Democrats' claim that Republicans have no solutions to replace Obamacare, according to a report from the American Action Forum.
The president's nominee to lead the Department of Health and Human Services, Rep. Tom Price (R., Ga.), has been working on health care reform since before Obamacare was signed into law and has introduced legislation known as the Empowering Patients First Act.
In June 2016, Speaker of the House Paul Ryan (R., Wis.) put together his "Better Way" agenda, which included a blueprint to fix health care with patient-centered reform.
Led by Rep. Mark Walker (R., N.C.), the Republican Study Committee introduced their alternative—the American Health Care Reform Act of 2017—shortly after the Senate voted to start a process to repeal parts of the Affordable Care Act.
Another plan, put forth by Sen. Bill Cassidy and Rep. Pete Sessions, known as the Patient Freedom Act of 2017 or the World's Greatest Healthcare Plan, would allow states to choose whether they want to keep Obamacare or replace it.
Finally, the Patient CARE Act, Improving Health and Health Care, and the 2017 Project are three more alternatives put forth by Republicans.
Most of these plans will keep popular parts of the Affordable Care Act, such as protections for individuals with preexisting conditions, children staying on their parents' plans until age 26, and a ban on annual and lifetime limits. President Trump has signaled he supports the first two provisions.
All seven plans listed above would maintain Obamacare's ban on insurers denying coverage and medically underwriting those with preexisting conditions, as long as individuals keep continuous coverage. Three plans, including A Better Way, PCARE, and the Patient Freedom Act of 2017, allow young adults to stay on their parents plan until 26. The 2017 Project allows coverage until age 25. Two of the seven replacements ban annual or lifetime limits, a measure that is also likely to be maintained.
Some of the new provisions offered by Republican replacements will be high-risk pools, selling insurance across state lines, and reforming Medicaid. For those individuals with preexisting conditions, six of the seven replacement plans would use federal funding to set up high-risk pools to ensure that they will still be covered. Republican alternatives also commonly allow the sale of insurance across state lines, which President Trump has supported, with the goal of increasing competition and lowering costs.
Finally, Republican replacement plans would likely reform Medicaid in some way by repealing it or modifying it through reconciliation. For example, there are four plans that would allow Medicaid funding to be used as a tax credit to purchase insurance in the individual market.
The report also notes that Republican replacements will either modify or replace some parts of the Affordable Care Act, such as offering continuous coverage instead of the individual mandate, putting a cap on the employer exclusion rather than the Cadillac Tax, offering tax credits instead of premium subsidies, and expanding the use of Health Savings Accounts.
House Majority Leader Kevin McCarthy (R., Calif.), who has worked with Ryan on his Better Way agenda, was asked at an event at the Hoover Institution about the claim that Republicans have no ideas when it comes to replacing Obamacare.
"We have numerous plans, numerous ideas we've put forth many times," said McCarthy. "What we've had was an administration that wanted to block or work against everything that we've done."
McCarthy said that following the election he sent a letter to every governor and insurance commissioner, regardless of party, to ask for their ideas.
"Let's have a system that everybody can have input in," McCarthy said. "Despite the way they went and passed Obamacare, let's create a system that works, brings greater choice."