4 main tenets of the GOP's ACA replacement plan

House Republicans gathered Thursday to discuss a policy memo detailing their ACA replacement plan, according to The Washington Post.

While the meeting put many rank-and-file members at ease, they said the details presented at the meeting did not comprise a full-on plan and instead created more of a roadmap, according to the report.

The policy brief, which is fairly similar to the Republican Better Way plan, does not include information on how it will be passed into law, according to the report. House Speaker Paul Ryan, R-Wis., has promised to deliver ACA repeal legislation by the end of the month, and President Donald Trump said Thursday a replacement plan will be ready in March, according to the report.

For now, the policy memo is the closest to a replacement plan available to the public. Here are its four key features.

1. "Portable" tax credits. Under the plan laid out in the memo, individuals who do not have employer or government-based insurance or who are dependent children under age 26 would be universally eligible for an advanceable, refundable monthly tax credit. The tax credit would be based on age, rather than income. Unlike the ACA's tax subsidies, the tax credits can be used on nearly any plan, including catastrophic plans. However, they cannot be used on plans that cover abortion.

The policy brief did not specify how much the tax credit would be.

To move to this system, Republicans proposed repealing any tax penalties for the individual mandate and employer mandate during the transition period. The brief did not specify if those mandates would be reinstated. People who receive ACA subsidies would essentially use those credits as the portable tax credits during the transition period.

2. Expanded health savings accounts. The GOP plan would increase the amount of money people can contribute to HSAs and give more flexibility to how they can add it. Currently, individuals can contribute a maximum of $3,400 to HSAs, and families can contribute a maximum of $6,750. Under the proposal, these caps would be increased and adjusted for inflation. If the policy goes into effect in 2017, for example, the maximum contribution limit would increase to $6,550 for individuals and $13,100 for families. The plan would also allow spouses to make contributions to the same HSA.

3. Reduce the Medicaid budget. The GOP wants to do this without "pull[ing] out the rug from anyone who received care under states' Medicaid expansions," according to the memo. The plan would repeal Medicaid expansion to able-bodied adults. However, to repeal this coverage without leaving people uninsured, Republicans propose continuing to pay enhanced federal funds to expansion states for a transition period of unspecified length. After this period is over, if a state elects to continue with Medicaid expansion, the federal government will only reimburse at "traditional match rates."

Republicans would then transition to a state-based per capita allotment program for Medicaid. States will receive the average Medicaid spending per enrollee in four different groups: aged, blind, disabled and children. States would also have the option to choose a block grant instead of per capita allotment. The amount of the block grant would be determined under the assumption that Medicaid expansion to able-bodied adults would be rolled back.

The plan would also repeal the ACA's cuts to disproportionate share hospital payments.

4. State innovation grants. Lastly, the Republicans laid out a plan for so-called "State Innovation Grants." Under this program, states would be given funding to create programs to "help repair state markets damaged by Obamacare." States will be able to choose how they spend these funds from a number of options, including reinstating high-risk pools, alleviating out-of-pocket costs or covering some preventive services.

The brief said the new innovation grants would be structured so that high risk pools would not lead to enrollment caps or waiting lists as they did in some states prior to the ACA. "These new and innovative State Innovation Grants are designed to help vulnerable patients," the brief reads. "Why would anyone allow them to potentially harm the very patients they are intended to help?"

To read more about the proposals, read the full policy memo here.


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