Republican leaders are refusing to commit to their ObamaCare replacement plan covering as many people as President Obama’s health law.
Congressional Republicans are quickly moving forward to pass a repeal of ObamaCare and say a replacement plan will come later this year.
But it’s unclear whether that eventual replacement will provide insurance options for at least 20 million people, the number who gained coverage under ObamaCare, amid worries that many could lose their health insurance.
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Speaker Paul Ryan (R-Wis.) on Thursday declined to commit when asked at a press conference if the Republican plan would allow everyone covered through ObamaCare to remain insured.
“Look, I’m not going to get ahead of our committee process,” Ryan said. “We’re just beginning to put this together.”
He instead called for a system “that gives us access to affordable healthcare in this country without a costly government takeover.”
Senate Majority Leader Mitch McConnell (R-Ky.) also declined to make a commitment when asked on Wednesday.
McConnell sidestepped a question about whether his priority was making sure no one with coverage now was left behind.
“Let me just say, we have on the floor of the Senate now the ObamaCare repeal resolution,” McConnell said. “The priorities between now and January 20th are hearings on Cabinet members.”
It is impossible to know how many people a GOP plan would cover, because Republicans are moving forward to repeal ObamaCare without an immediate replacement.
That means that any measure to repeal the current law will be done without knowing the alternative.
Republicans have also discussed passing a series of replacement bills step-by-step, avoiding one massive bill like the Affordable Care Act (ACA). But that approach could increase uncertainty about how the pieces will end up fitting together in terms of coverage.
Kellyanne Conway, a top adviser to President-elect Donald Trump, took a different approach this week and pledged that a replacement plan would cover the same number of people.
“If Americans have healthcare today under the Affordable Care Act, will they have healthcare — it sounds like Donald Trump is saying they will have healthcare — under whatever replaces it?” host Joe Scarborough asked Conway on MSNBC’s “Morning Joe” on Tuesday.
“That is correct,” Conway replied. “We don’t want anyone who currently has insurance to not have insurance.”
Democrats seized on the comments, vowing to hold Republicans to that pledge.
Andy Slavitt, who oversees ObamaCare as head of the Centers for Medicare and Medicaid Services, tweeted that Conway’s remarks are “a promise that Americans expect to be kept.”
But that will be a tall task for Republicans, and congressional leaders are being careful not to make the same commitment.
House Majority Leader Kevin McCarthy (R-Calif.) also declined this week to make a guarantee that a replacement would cover the same number of people as ObamaCare. He noted that there are other issues to consider besides coverage.
“There’s a lot of areas that you want to look at,” McCarthy told reporters Tuesday. “You want to look at a system that works, you want to look at a system for cost purposes, you want to look at a system to have greater choices, but you want to be able to care for those at the same time who can’t have healthcare so all those will go into the mix to make the very best healthcare [plan].”
Larry Levitt, a health policy expert at the Kaiser Family Foundation, said that Republicans are likely to put more of a priority on reducing federal spending and regulations than covering as many people as the ACA.
“It will be very hard for any replacement plan that spends less than the ACA to cover as many people, and scaling back rules for required benefits will lead to skimpier coverage,” Levitt wrote in an email.
Republican plans generally offer a tax credit to help people afford coverage, but they offer a flat amount based on age. Under ObamaCare, those credits are based on income to give low-income people more assistance.
Republicans are also taking aim at ObamaCare’s “essential health benefits,” which mandate which services a plan must cover. They argue that Washington should not be mandating which insurance plans people can buy, and loosening those regulations would provide the option of cheaper plans that cover less.
That means a large number of people could be covered under a Republican replacement, but with less generous coverage including, for example, high deductibles or plans that don’t cover certain areas, like prescription drugs.
“Flat dollar tax credits combined with minimal regulation of benefits could lead to a significant number of people covered but with very skimpy benefits as insurers market plans that people can buy with their tax credits,” Levitt wrote.
Republicans also need to figure out how to pay for their replacement plan.
Repealing ObamaCare’s taxes would mean that there is far less money available to pay for a plan. Republicans are considering keeping some taxes in place, though that idea is drawing blowback from conservatives who want to repeal the whole law.
Those complications could lead to a tricky situation for Republicans.
Joe Antos, a healthcare expert at the conservative American Enterprise Institute, likewise said that Republicans dialing back ObamaCare’s increased federal spending on Medicaid and moving to less generous financial assistance would likely mean a GOP plan would cover fewer people.
“Some people will definitely drop off of coverage if these are the kind of policies that go forward,” he said.