What we know about Republicans’ ACA replacement

New details have come out about House Republicans’ alternative to the Affordable Care Act after a closed-door discussion on Capitol Hill May 12.

A four-member task force convened by House Speaker Paul Ryan, R-Wis., has been working on the specifics of the proposal for months. The private meeting was the first time a draft of the plan was laid out by the task force.

Here are some aspects of the plan that have been revealed so far:

Changes to Medicare and Medicaid

The Hill reports the plan now encompasses Medicare and Medicaid reforms that have been floated by Republicans several times before. The plan would reportedly incorporate an earlier proposal from Ryan, giving seniors currently covered by Medicare a voucher to seek private insurance. For Medicaid, the ACA’s expansion would be rolled back, and Rep. Phil Roe, R-Tenn., MD, said a “per capita cap” would be introduced to limit the amount of federal funding to individual beneficiaries in each state.

Capping or Eliminating Employer Tax Benefits

Rep. Joe Pitts, R-Pa., told POLITICO a broad goal of the Republican is to make coverage less tied to employment.

“Employer sponsored insurance is a critical part of our healthcare system and must be protected, but for many, their health insurance is too closely tied to employment,” Pitts said, “People who are laid off, fired or have to quit working can find themselves uninsured at a time when they can least afford it. We need better options.”

To start that separation, the task force is proposing capping or eliminating the tax credit for employers that offer health benefits. Republicans who have heard more about the proposal said the credit discriminates against people with individual health coverage.

Continuous Coverage—But What About Pre-Existing Conditions?

Playing into a partial move away from employer-sponsored insurance, several members of the committee have said a goal of the plan is “continuous coverage,” even for people who are sick.

Yet Ryan himself has publicly criticized the ACA for preventing insurers from charging people with pre-existing conditions higher rates, and advocated for moving those more expensive customers to high-risk pools run by the states.

“Let's fund risk pools at the state level to subsidize their coverage, so that they can get affordable coverage," Ryan said at Georgetown University in April. "You dramatically lower the price for everybody else. You make health insurance so much more affordable, so much more competitive and open up competition."

Democrats have criticized risk pools, saying they’ve been shown to be ineffective when federal and state funds aren’t available to subsidize coverage.

What isn’t clear is where this leaves earlier promises by House Republican leaders to retain the ACA’s guarantee of coverage for people with pre-existing conditions.

Less Detailed Proposals

Some of the leaks have only offered vague hints at certain facets of the plan:

•  Allowing insurers to sell across state lines;
•  “Beefing up” health savings accounts.

No Actual Legislation

Members of the task force told The Hill it’s on schedule to publicly release the plan in June, but it won’t be as legislation that Congress could vote on. Instead, it will be a white paper, offering more details than a policy statement, but less information than a bill would provide on the potential costs of the plan and how many people with coverage under the ACA would be affected.