The next big hurdle for Republicans: Scoring the replacement plan

Last night Republicans unveiled their Affordable Care Act (ACA) replacement plan. This is something that has been highly debated not only in recent months, but over the past several years.  

Several leaders in the Republican Party, including Rand Paul and Senator Bill Cassidy, had already proposed plans, but the GOP hadn’t yet agreed on what should happen next. The debate centered on what provisions of the ACA (if any) to keep intact, whether repeal should happen without a replacement plan, and when a replacement plan should take effect (either immediately or in several years). 

The proposed plan replaces federal insurance subsidies with individual tax credits and grants, giving more power to the states to form their own policies. It aims to repeal the individual mandate, but retains two of the most popular provisions of the ACA -- allowing young adults to remain on their parents’ health plan until age 26 and protecting individuals with preexisting medical problems.

Now Republicans will wait in suspense as the Congressional Budget Office (CBO) “scores” the plan. As part of this process, the CBO will evaluate the number of Americans that would receive or lose coverage under the new bill, as well as the net impact the bill would have on the federal budget. 

Republicans have already been facing scrutiny from their constituents regarding their campaign promise of repeal and replace, so if the CBO’s assessment indicates that fewer Americans will be covered under the new bill than under the ACA, or that the bill will have a greater negative impact on the federal budget, it will be very difficult for Republicans to justify moving forward with the plan.

Here are the elements of the replacement plan that the CBO will look at as part of the scoring process:

  • Medicaid rollback
  • Elimination of the individual and employer mandates
  • Creation of new tax credits (both the amount of credit and application of the credits)
  • Emphasis on consumer-driven health plans, such as Health Savings Accounts (HSAs)
  • Comprehensive coverage requirements

While the CBO’s evaluation of a bill is not in any way a legally binding assessment that impacts the legislative process, it will be an important factor in justifying how Republicans proceed with their replacement strategy. 

Stay tuned to the SyncStream blog for updates and analysis of proposed health care reform.