House GOP Lays Out Healthcare Vision in Blueprint

Republicans in the House of Representatives this week laid out their alternative to the Affordable Care Act (ACA) in an effort to position themselves against various Democratic healthcare proposals.

The Republican Study Committee (RSC) called the plan “practical solutions to repair our broken healthcare system.” This first part of their plan lays out their vision should the Republicans regain the House of Representatives and should Donald Trump be reelected to the presidency in 2020.

The document contains many ideas that have been debated previously when Republicans tried to repeal the ACA, and it draws on work from the Heritage Foundation and the Cato Institute.

While the ACA contains many regulatory provisions and pathways such as the Biologics Price Competition and Innovation Act or BPCIA, and forms the Center for Medicare and Medicaid Innovation in CMS, this first part of the RSC plan is silent on those issues, though they may be discussed in the next release of the plan.

The RSC said a second report will follow, with additional recommendations “to further reduce the cost of healthcare and increased transparency competition and innovation technologies. This will include recommendation on policies like transparency competition in reducing barriers to technological innovation.”

Among other things, the plan released Tuesday addresses pre-existing conditions, access to primary care, health savings accounts (HSAs), and more.

While the plan retains protection for pre-existing conditions, it removes the ACA provision that kept insurers from charging patients with costly healthcare needs more money, through the introduction of high-risk pools. The plan calls these “guaranteed coverage pools” to be funded by the subsidies that previously went to exchange plans for those who qualified for help paying premiums, as well as ending and diverting Medicaid expansion funds.

The plan would end Medicaid expansion and replace Medicaid with a block grant; states that adopt a work requirement may be eligible for more funding. Republicans call this “rightsizing” Medicaid.

“There is no reason why an able-bodied adult without any dependents should be more heavily subsidized” than “a poor pregnant woman, elderly person, child, disabled individual, or parent,” the document states.

The blueprint also focuses heavily on HSAs. It increases the amount that an individual or family could contribute; the current limits are $3500 for an individual and $7000 for family. The RSC plan would increase those amounts to $9000 per individual and $18,000 for families.

In addition, the scope of eligible expenditures for HSAs would expand as they would be allowed to issue reimbursements for health insurance premiums. The RSC plan would also sever the rule that HSAs be linked to a high-deductible health plan.

It also champions short-term healthcare plans and association healthcare plans, as well as “healthcare sharing ministries,” in which people with a common set of beliefs pool their money and share medical expenses among themselves. Under such an arrangement, those pulling the money could decide what they will and will not pay for—such as reproductive health care.

Another model backed by Republicans is the direct primary care model, in which patients pay a monthly fee to a provider instead of an insurance copayment or coinsurance. The fee covers primary care services, clinical laboratory services, consultations, care coordination, and comprehensive care management.

The plan also recommends expanding access to telemedicine by ending state regulatory barriers.