Consensus emerging in GOP on how to replace ObamaCare

After years of trying, Republicans are coalescing around the outlines of a plan to repeal and replace ObamaCare.

Jeb Bush unveiled an ObamaCare alternative on Tuesday that is similar to the proposals from Sen. Marco RubioMarco RubioBush ethics lawyer: Congress must tell Trump not to fire Mueller The private alternative to the National Flood Insurance Program  Cruz offers bill to weaken labor board's power MORE (R-Fla.), his presidential rival, and former 2016 hopeful Gov. Scott Walker. The Bush plan overlaps significantly with proposals from congressional Republicans.

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The plans all center on a tax credit intended to help people afford health insurance, along with more limited protection for people with preexisting health conditions and a cap on federal payments to states for the low-income Medicaid program.

Bush's plan "seems to reflect an emerging consensus among Republicans about what the Affordable Care Act (ACA) should be replaced with,” said Larry Levitt, senior vice president at the Kaiser Family Foundation, which conducts nonpartisan health analysis. 

“For folks who want to move in the direction of the patients, the options are pretty clear, I think,” said Rep. Tom Price (R-Ga.), who has authored a plan that is similar to Bush’s, Rubio’s and Walker’s.

But despite the general agreement on the outlines of a plan, Republicans are a long way from getting an ObamaCare alternative enacted.

For a plan to have any chance, a Republican would have to win the White House in 2016. Even then, Democrats could block a proposal in the Senate, provided that Republicans don’t do away with the filibuster.

Furthermore, Republicans would face a political risk if they disrupted coverage for the millions of people enrolled under ObamaCare, and could be confronted with difficult tradeoffs, including how to pay for their plans, when drafting legislation. 

Still, the move toward a consensus among the party’s presidential contenders could help Republicans fight back against Democrats, who have long argued that the GOP doesn’t have a plan to help the uninsured — partly because no legislative proposal has reached the floor.

Asked if he was disappointed that GOP leadership has not held a vote on his plan, which has been around for years, Price said an alternative would have to wait for a new president. 

“Nobody holds out any hope for this president to wake up and realize that his healthcare plan is remarkably flawed,” he said.  

The emerging Republican proposals are designed to be simpler and less costly than ObamaCare. They would do away with the health law’s requirements that insurance plans offer fairly comprehensive benefits, which Republicans say are driving up premium costs.

Bush, for example, touted cheaper, less comprehensive plans that only cover “catastrophic” events.

On top of those plans, “whatever else people want insurance to cover, they’ll be able to buy that, and we won’t force people to buy coverage they don’t want, either,” Bush said. 

The Republican proposals come with tradeoffs. The tax credits in Republican plans tend to be based on age, in contrast to ObamaCare’s tax credits, which are based on income and therefore give poorer people more assistance. 

“The Bush plan would provide much more help to higher income people than the ACA, but much less help to lower-income people,” Levitt said. 

Tom Miller, a healthcare expert at the conservative American Enterprise Institute, said that when drafting a plan, “you can be very generous to folks on the bottom level and do full-scale redistribution,” much like ObamaCare.

The alternative, he said, is “you can feed the middle class first, and I think you can expect to see Republicans feeding the middle class.”

The Republican approach would weaken some of the protections now in place for pre-existing conditions.

ObamaCare bans insurers from denying coverage for health reasons, and pairs that with a mandate for people to buy insurance intended so that people don’t wait until they are ill to purchase coverage.

Republican plans drop the mandate, which they denounce as infringing on individual liberty, while providing less protection for people with pre-existing conditions. 

Bush’s plan, as well as a proposal from Rep. Fred Upton (R-Mich.), Sen. Richard BurrRichard BurrBurr: Nunes 'created' unmasking allegations against Rice Susan Rice met with Senate Intelligence Committee as part of Russia probe Overnight Cybersecurity: State Department reportedly eliminating cyber office | Senate Intel chief avoids White House during Russia probe | Dem pushes 'ethical hacking' resolution MORE (R-N.C.) and Sen. Orrin HatchOrrin HatchSenate panel advances Trump's tax policy nominee Healthcare debacle raises pressure for GOP on taxes GOP frets over stalled agenda MORE (R-Utah), includes protections only for people with “continuous” coverage. That means people with pre-existing conditions would only be protected if they remain insured.

Rubio and Price’s plans focus on high-risk pools, where people with pre-existing conditions could buy government-subsidized plans. Liberals tend to criticize high-risk pools as having high premiums that are out of reach for many. 

Another major question for Republicans is how to pay for the tax credits and other costs in the plans. ObamaCare is funded by several new taxes that Republicans in Congress are fighting to repeal.

The GOP could find savings from capping Medicaid payments and by limiting how much of employer-sponsored health plans remain tax-free, but experts say without more details, it’s hard to know how well the plan would work.

“These are markers for where the candidates would like to go,” said Miller, of the American Enterprise Institute. “Every battle plan doesn’t survive the first shot being fired.”