GOP lawmakers get details on Ryan Obamacare repeal plan and advice on how to sell it | McClatchy Washington Bureau

Congressional Republicans, anticipating confrontations with angry Affordable Care Act supporters during the upcoming February recess, have been given talking points by party leaders to counter and deflect the growing public rancor.

House Speaker Paul Ryan, R-Wis., on Thursday provided an outline of the ACA repeal legislation that Republicans will introduce after Congress returns on Feb. 27.

But former Obama administration health advisers said the document and its strategy recommendations for GOP lawmakers couldn’t hide the fact that Republicans still hadn’t produced a definitive plan to replace Obamacare.

“Because the vast majority of the public has been making clear they do not want their care ripped away from them with nothing else in its place, this is going to be an especially interesting recess period,” said Andy Slavitt, who was the Medicaid administrator under President Barack Obama.

The GOP plan to address angry constituents, outlined in a 17-page policy brief, is a familiar one: Reiterate that “Obamacare has failed” and the Affordable Care Act is “only getting worse,’’ tell voters that repealing the health law “is relief” and assure them that Republicans will provide “a stable transition” that won’t leave people without coverage.

Most importantly, GOP lawmakers are being urged to insist that “we have a better way” to provide health care to millions of Americans.

Ryan presented his still-developing repeal plan with the Republican conference behind closed doors on Thursday along with House Ways and Means Committee Chairman Kevin Brady and Energy and Commerce Committee Chairman Greg Walden.

While still short on details, the “Better Way” proposal calls for replacing current ACA subsidies that help people purchase marketplace coverage with a universal health care tax credit that would be used the same way.

But because the amount of Ryan’s flat tax credit would be based on age and not income, those with lower earnings would have a harder time paying for coverage, said Jeanne Lambrew, former deputy assistant for health policy to Obama.

It’s also unclear whether Ryan’s tax credit would be geographically adjusted for regional cost differences. And because it wouldn’t adjust for unexpected premium hikes, Lambrew said, “the consumer, not the government, will bear the full brunt of that.”

Ryan’s plan also calls for repealing the ACA’s Medicaid expansion and giving states that did so a “limited time period” to continue the enhanced federal funding for their newly eligible recipients – no less than 90 percent of their medical costs.

Eventually, those enrollees would be funded at the basic Medicaid level, forcing states to bear more of their costs or to limit their eligibility for Medicaid.

Ryan’s plan would also give states the choice of moving their Medicaid programs to a block grant or per capita cap funding formula.

Currently, the federal government pays a share of each state’s Medicaid spending – anywhere from 50 to 80 percent – with no limit on total costs.

Block grants would give states a fixed amount of federal dollars each year to run Medicaid. Critics say block grants would force states to tighten enrollment requirements or cut benefits in the event of enrollment spikes due to economic downturns.

When Ryan offered a similar block grant plan in 2011, the nonpartisan Congressional Budget Office found it would cut federal Medicaid spending by 35 percent from 2013 to 2022.

A “per capita cap” provides funds for each Medicaid beneficiary up to a specified amount. Both block grants and caps would end Medicaid’s guarantee of coverage for all who qualify and would require restructuring program eligibility and coverage rules.

Ryan’s plan would also resurrect high risk pools, dubbed “state innovation grants.”

In 35 states, 226,000 people who were unable to get private insurance in the days before Obamacare found coverage through state high-risk pools, a safety-net program for the medically uninsurable.

Under Obamacare, premiums for sicker, costlier consumers’ are supposed to be held down because they’re part of a pool that includes healthier people.

Ryan’s plan would put these higher-cost enrollees into state-run high risk pools so private insurers could charge lower premiums for everyone else.

“None of the ideas we’re hearing would come anywhere close to replacing the ACA on coverage, quality and affordability, much less make things better,” Slavitt said of Ryan’s plan.

Political uncertainty surrounding the ACA and the Internal Revenue Service’s intent to not strictly enforce the individual mandate are the real cause of instability in the individual insurance marketplace, Slavitt said.

Based on President Donald Trump’s executive order that federal agencies reduce the burdens of the ACA, the IRS apparently won’t penalize people who don’t have insurance coverage, even though it’s a violation of the ACA’s individual mandate that requires them to have it.

“The IRS has decided to make changes that would continue to allow electronic and paper returns to be accepted for processing in instances where a taxpayer doesn’t indicate their coverage status,” an IRS announcement said.

Without enforcement of the mandate, individual market insurers fear many plan members will drop their coverage. The uncertainty makes it hard for insurers to estimate their premiums for the 2018 coverage year, Slavitt said.

Ryan also wants to repeal all the ACA taxes that helped pay for plan members’ premium subsidies.

Rep. Kevin Cramer, R-N.D., who met with Trump at the White House on Thursday with other GOP lawmakers, questioned whether lawmakers will be able to repeal all the Obamacare taxes and replace them with spending.

Rep. Frank Pallone of New Jersey, the ranking Democrat on the House Energy and Commerce Committee, said the Republican proposal was still too vague to call a plan.

Pallone said there was nothing “in what they put out that’s a real replacement that’s meaningful and that covers the majority of people who got coverage under the Affordable Care Act.”