"Replace 20 million people’s health insurance with 37 pages of talking points."


That's the subheadline of Jonathan Cohn & Jeffrey Young's story this morning about the kind-of, sort-of "replacement plan" for the ACA which Paul Ryan and the House Republicans have finally come up with, more than 6 years after the ACA was signed into law:

The plan, which isn’t legislation and is more like a mission statement, lacks the level of detail that would enable a full analysis, but one thing is clear: If put in place, it would almost surely mean fewer people with health insurance, fewer people getting financial assistance for their premiums or out-of-pocket costs, and fewer consumer protections than the ACA provides.

It’s difficult to be certain, because the proposal, which House Speaker Paul Ryan(R-Wis.) will talk up at the American Enterprise Institute in Washington on Wednesday, lacks crucial information, like estimates of its costs and effects on how many people will have health coverage.

The document weighs in at 37 pages, which includes the cover, three full pages about how terrible Obamacare is, and two blank sheets.

...The language used for the House GOP’s diagnosis of the ACA and their prescriptions for the health care system, however, make plain the party’s ideas haven’t advanced much since the 2009 messaging memo from Republican operative Frank Luntz that framed the debate in Congress.

And after all this time, a senior Republican House leadership aide told reporters Tuesday that it wouldn’t be until next year that House committees may attempt to convert these proposals into legislation, and there will be no deadline for them to do so.

OK, so what's actually in the plan?

First up, it repeals just about everything in the ACA (except, oddly, for the "young people staying on their parents' plan" provision), which means...

  • No more individual mandate (so much for the three-legged stool)
  • People with pre-existing conditions can once again be kicked to the curb.
  • Goodbye, Medicaid expansion!
  • Toodle-oo APTC and CSR financial assistance
  • The Return of the Junk Policy

...which would be replaced by:

  • "Selling Across State Lines!" (which the ACA actually already allows for, and which insurance carriers don't appear to be interested in anyway)
  • The return of High Risk Pools (which many states used to have, and which everyone agreed sucked)
  • Health Savings Accounts paired with high-deductible insurance (ironic, given that high deductibles are one of the problems everyone is becoming increasingly worried about under the ACA)
  • Capping medical malpractice awards (even though tort reform appears to make things worse, not better).
  • Allowing carriers to charge older people five times as much as younger people (which is great if you're young...and horrible if you're old) instead of the current three times restriction
  • Only requiring people with pre-existing conditions to be covered if when they renew their policies
  • Replacing income-based APTC/CSR with...an age-based tax credit.

Oh, yeah, and it would also wipe out Medicare and Medicaid (hello, block grants!) as we know it, while also raising the age on Medicare to 67.

Ironically, for all the complaining by pretty much everyone about the "Cadillac tax" in the ACA, the GOP plan would replace that with...pretty much the same thing:

Another key element of the proposal is a major change to the tax treatment of job-based health insurance. Now, neither employers nor workers pay taxes on the value of this coverage, and liberal and conservative economists agree current policy distorts the market and disproportionately benefits higher-income households. The House GOP proposal would cap this tax benefit at an unspecified amount. It’s similar in approach to Obamacare’s unpopular Cadillac tax on high-cost health plans.

In general, it's a mish-mash of stale ideas, some of which have already been tried (and failed) in the past, others of which are of either dubious benefit or utterly unknown results, since it doesn't provide enough detail for the Congressional Budget Office to even attempt an analysis. Overall, however, Cohn/Young sum it up as follows:

In the schemes they have in mind, either fewer people end up with insurance, the people with insurance end up with less coverage, or some combination of the two.