Wash. D.C. New York Times
Republicans in Congress have been saying for months that they are working on a plan to repeal and replace Obamacare in the Trump era. Now we have the outline of that plan, and it looked as if it would redirect federal support away from poorer Americans and toward people who are wealthier. A white paper drafted by House leadership and the staff of the house and Senate committees that oversee health policy details a structure that could replace large sections of the Affordable Care Act. Crucially, the proposal largely contains provisions that could be passed through a special budget process that requires only 50 Senate votes, and fulfills President Trump’s promise that the repeal and replacement of the law would take place “simultaneously”.
The plan would make major changes in how health care is financed for Americans who don’t get coverage from work. It would greatly expand the number of American’s who could benefit from federal help in buying health insurance, but it would change who benefits most from that support. Obamacare, as the ACA is known, extended health coverage to 20 million Americans through two mechanisms, it expanded Medicaid coverage to Americans belwo or just below the poverty line in states that participated, and it offered income based tax credits for middle income people to buy their own insurance. Obamacare was a redistributive law, transferring money from the rich to the poor.
The Republican plan would have altered both of those programs, changing the winners and losers. It would substantially cut funding for states in providing free insurance to low income adults through Medicaid. And it would change how tax credits are distributed by giving all Americans not covered through work a flat credit by age, regardless of income. But the current system is set up to ensure that low and middle income Americans can afford the cost of their premiums. The Republican plan would not do that, and would result in many more low income people losing out on coverage if they couldn’t find the money to pay the gap between their fixed tax credit and the cost of a health plan.