ACA repeal plan leaks, but Trump may offer different version in speech to Congress

President Donald Trump is expected to lay out some details on his favored plan to repeal and replace the Affordable Care Act (ACA), while parts of the House Republicans’ newest proposal leaked out, revealing it would eliminate subsidies for buying insurance and the expansion of Medicaid.

The draft bill, first obtained by POLITICO, would replace the current income-based tax credits with subsidies based on age. A 30-year-old would receive $2,000 per year, while a 60-year-old would get $4,000 annually.

The individual mandate would be scrapped, as would all of the ACA’s taxes. It would also bring back high-risk pools to cover patients with pre-existing conditions, offering $100 billion to states to implement those programs.

All of this would be paid for through a single provision: capping the tax exemption for employer-sponsored coverage at the 90th percentile of current premiums, similar to the ACA’s “Cadillac tax.”

But Trump may have some different ideas. Speaking to the National Governors Association on Feb. 26, he said “perhaps” he’ll lay out parts of his healthcare plan in his scheduled address to a joint session of Congress on Feb. 28.

“I think you're going to see something very special,” Trump said, according to CNN.

Governors participating in the events with Trump over the weekend cast doubt on the House Republicans’ plans in terms of Medicaid. The draft would roll back the expansion, though states could get additional funding capped based on the total number of Medicaid enrollees.

Among the compromises being discussed are increasing disproportionate share hospital (DSH) payments to facilities that treat more low-income or uninsured patients, but for some Republican governors, that’s a non-starter.

“I don’t think that paying hospitals for uncompensated care results with a healthier population,” said Ohio Gov. John Kasich, according to the Washington Post.

Another issue with the repeal-and-replace path appears to how Trump can be swayed. According to the Post, he seemed receptive to Kasich’s alternative ideas in a Feb. 24 meeting at the White House, even asking to get HHS Secretary Tom Price on the phone during the visit. 

When Jared Kushner, Trump’s adviser and son-in-law, reminded Trump of ways the House plan differed from what Kasich was advocating, the president reportedly replied, “Well, I like this better.”