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Politics: G.O.P. Plans to Replace Health Care Law With ‘Universal Access’

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WASHINGTON — House Republicans, responding to criticism that repealing the Affordable Care Act would leave millions without health insurance, said on Thursday that their goal in replacing President Barack Obama's health law was to guarantee " universal access " to health care and coverage But, he said, the date that those provisions would actually disappear would be delayed, allowing a transition period as short as two years or as long as three or four years. During that time, Republicans plan to pass one or more replacement bills. By giving people the choice to buy insurance, Republicans could

The taxes from the 2010 health care law will be repealed. That includes taxes on prescription drugs, over-the-counter medications, health -insurance premiums and medical devices. As for how the plan will be paid for, an explanation on the House GOP website says, "We are still discussing details, but we are committed to repealing Obamacare and replacing it with fiscally responsible policies that restore the free market and protect taxpayers." Correction: Tax credits under the GOP plan will be ,000 to ,000 per year; this story originally specified a different time period. We also clarified that essential

Speaker Paul D. Ryan portrayed repeal of the health law not as an ideological crusade, but as a form of urgently needed relief. © Sam Hodgson for The New York Times Speaker Paul D. Ryan portrayed repeal of the health law not as an ideological crusade, but as a form of urgently needed relief.

WASHINGTON — House Republicans, responding to criticism that repealing the Affordable Care Act would leave millions without health insurance, said on Thursday that their goal in replacing President Obama’s health law was to guarantee “universal access” to health care and coverage, not necessarily to ensure that everyone actually has insurance.

In defending the Affordable Care Act, the Obama administration, congressional Democrats and advocacy groups have focused on the 20 million people covered by the law, which has pushed the percentage of Americans without health insurance to record lows. The American Medical Association recently said that “any new reform proposal should not cause individuals currently covered to become uninsured.”

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Universal healthcare (also called universal health coverage, universal coverage, or universal care ) is a health care system in which all residents of a particular country or region are assured access to

Health care is (yuge) this year. Huge. And it will continue to be a contentious topic for years to come, as Americans not only wait to see what the final Republican health care alternative looks like, but also to understand when and how it will impact their lives. The current political forecast shows that If Republicans stay the course, their “repeal and replace ” plan will come out of two budget reconciliation bills in 2017. The first bill will likely repeal the federal health law ’s taxing and spending provisions (think Medicaid expansion and health insurance subsidies) by 2019, while the second outlines tax reform

But House Republicans, preparing for a rapid legislative strike on the law next month, emphasize a different measure of success.

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“Our goal here is to make sure that everybody can buy coverage or find coverage if they choose to,” a House leadership aide told journalists on the condition of anonymity at a health care briefing organized by Republican leaders.

Republicans have an “ironclad commitment” to repeal the law, the aide said, as lawmakers moved to discredit predictions that many people would lose coverage.

“There’s a lot of scare tactics out there on this,” said Representative Kevin Brady, Republican of Texas and chairman of the Ways and Means Committee. “We can reassure the American public that the plan they are in right now, the Obamacare plans, will not end on Jan. 20,” the day Donald J. Trump will be inaugurated.

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The GOP plan would increase that limit. It would also lower penalties for the health care equivalent of early withdrawal – spending the money on non- health care costs. HSAs act a bit like a second IRA , because the money can ultimately be used for retirement, so this is a very good thing for workers who already max out other retirement plan options. Older Obamacare consumers will almost certainly see their premiums rise under the GOP plan . Obamacare allows insurers to charge older consumers up to three times more than younger consumers. With the GOP health care bill, that jumps to a factor of five.

Advocates of the president’s health care law — and some health care experts who have analyzed the Republicans’ proposal — say the emerging plans would simply put the health care system back to where it was before the law , with too many people uninsured and too many sick people driving up costs. They hope to keep health care a front-burner issue — and turn the 2016 election into a choice between Mr. Obama’s health care program and a detailed, conservative alternative. “There’s an untapped discussion out there,” said Douglas Holtz-Eakin, a former Congressional Budget Office

The suggestion that 20 million people will lose coverage is a “big lie,” Mr. Brady said, after meeting here with Republican members of his committee.

“Republicans,” he said, “will provide an adequate transition period to give people peace of mind that they will have those options available to them as we work through this solution.”

Republicans have not settled on the details or the timing of their replacement plan. The House speaker, Paul D. Ryan of Wisconsin, portrays repeal of the law not as an ideological crusade, but as a form of urgently needed relief.

“Insurance markets are collapsing,” Mr. Ryan said this week. “Premiums are soaring. Patients’ choices are dwindling.”

The House leadership aide said that repealing major provisions of the law was a priority for the first 100 days of the Trump administration. But, he said, the date that those provisions would actually disappear would be delayed, allowing a transition period as short as two years or as long as three or four years. During that time, Republicans plan to pass one or more replacement bills.

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Speaker Paul D. Ryan portrayed repeal of the health law not as an ideological crusade, but as a form of urgently needed relief.Credit

By giving people the choice to buy insurance, Republicans could end up dangerously skewing the health insurance market, Obama administration officials and insurance executives say. Sick people are more likely to sign up, they say, and there may not be enough healthy people paying premiums to cover the costs for those who are less healthy.

Under the Affordable Care Act, people who go without insurance are subject to tax penalties. The Internal Revenue Service says that more than eight million tax returns included penalty payments for people who went without coverage in 2014.

The House leadership aide said that lowering the cost of insurance was a much better way to encourage people to opt in.

“We would like to get to a point where we have what we call universal access, where everybody is able to access coverage to some degree or another,” the aide said. “Over the past six years, if you look at the experience we’ve had with the A.C.A. rollout, chasing coverage doesn’t necessarily yield great outcomes. You can have people going into an exchange, finding out that their pediatrician is no longer available to them.”

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The House leadership aide said House Republicans had not decided on the future of cost-sharing subsidies that are paid by the federal government to insurance companies. Such subsidies are intended to reduce out-of-pocket costs for millions of low-income people buying insurance under the Affordable Care Act.

A federal district judge, responding to a lawsuit filed by the House, ruled in May that the Obama administration had paid billions of dollars to insurers since January 2014 even though Congress had not appropriated money for such “cost-sharing reductions,” and that the payments therefore violated the Constitution. Without that money, estimated at $130 billion over 10 years, insurers would increase premiums or pull out of the insurance exchanges, creating chaos for consumers, some health policy experts say.

But now that the House leadership has won a legal victory, Republicans have not decided how to proceed. The aide declined on Thursday to say if Republicans would seek an immediate halt to the cost-sharing subsidy payments. He did not rule out the possibility that a Republican-controlled Congress might keep the money flowing for a transition period, to stabilize the market while Republicans develop alternatives to the health law.

“It’s an open question,” he said.

Republicans said they were more interested in vindicating Congress’s constitutional power of the purse.

In any event, the House leadership aide said, Republicans do not intend to pull the rug out from people who have gained insurance under the Affordable Care Act.

“This has never been about taking something away or dismantling something,” the aide said. “This has always been about making health care markets work, making health care reform work. We view Obamacare as going in the opposite direction from that.”

Trump could quickly doom ACA cost-sharing subsidies for millions of Americans .
Obama officials, insurers predict move would create chaos in health law’s marketplaces.Given that insurers would still be required to provide consumers that financial help, such a move could create upheaval in the ACA’s marketplaces — prompting health plans to raise their prices or drop out, according to health-policy experts in both major political parties.

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