Ryan indicated that tax credits for consumers are likely to replace the government subsidies now provided to about 85% of Americans who purchase their health coverage from the Obamacare exchanges.
Republicans also want to lower taxes on the rich, but find that the cost of prohibiting exclusions and allowing children coverage to age 26 under Obamacare is paid for with a tax on the rich.
Leavitt says the desire to retain popular elements of the Affordable Care Act and avoid negative impacts of precipitously unwinding the law will dictate more modest changes. The menus of insurance companies, coverage and doctor networks are set up throughout the country because there are federal employees everywhere.
Reproductive health advocates faced down a similar threat when Congress was crafting Obamacare in 2010. However, they can not be used on plans that cover abortion. Instead, they supposedly offer "universal access" - that is, you can have health insurance, if you can pay for it.
The replacement proposal, introduced by Sen.
Under the approach outlined on Thursday, Ryan and his colleagues would seek to alleviate this problem by removing the federal funding only gradually, and giving states times to adjust. I've heard anecdotal stories about this from a few Obamacare enrollees I've interviewed, who chose to take slightly fewer hours so they could qualify for Medicaid, which offers more generous benefits than the marketplace. Ten states limit it on all private insurance plans.
The new Republican plan is a bit like the Stupak amendment on steroids. Under Obamacare, people who earn less than 200 percent of the poverty line (about $24,120 for an individual or $49,200 for a family of four) get the most generous help.
"A tax credit is a fixed amount (for consumers) to go buy the health plan of their choosing", Ryan said.
Why not? In public, they claim Medicaid is too bureaucratic, fraud-plagued, and costly.
The last item in the GOP's replacement plan calls for the creation of high-risk pools, which would be funded by federal dollars allocated to the states and can be used to help those with pre-existing conditions. Some might suggest that women could purchase special riders to cover abortion, but those sorts of add-ons haven't worked particularly well in health insurance, since they tend to be extremely expensive. With great power comes great responsibility, a comic book once said, and with total control of the government, the GOP feels the need to save the exchanges or face the consequences. Also eliminated would be the subsidies the government provides most people who buy coverage on the online marketplaces the statute established. "What is not clear is why", Sonfield told me.
While some are concerned an estimated 22 million people would lose medical insurance if the Affordable Care Act were repealed, others believe flaws in the ACA, nicknamed "Obamacare", mean it should be scrapped and redone entirely.
Of course, that might be the only part of health reform every Republican will be able to get behind.