The plan would repeal major functions of the ACA, including individual and employer mandates, Medicaid expansion, tax-subsidies provided to low-income Americans to gain insurance coverage, and the ban on physician-owned hospitals.
The House Republican proposal would repeal the fiscal year (FY) 2018 and 2019 Medicare Disproportionate Share Hospital (DSH) cuts, the 2018 through 2020 Medicaid DSH cuts, and create a “combined national pool of uncompensated care funds” in 2021. The policy would require the Health and Human Services Secretary to distribute funds from the uncompensated care pool to DSH hospitals based on the use of certain federally collected data.
Additionally, the plan suggests repealing two programs passed through the ACA – the Independent Payment Advisory Board (IPAB), a 15-member board tasked with proposing cuts to Medicare if spending exceeds set targets, and the Centers for Medicare and Medicaid Innovation (CMMI), which tests and evaluates payment and care delivery models – and repeals the Medicare Advantage benchmark caps.
Although the proposal repeals major components of the ACA, it does keep some policies, including insurance coverage for those with pre-existing conditions and allowing young adults to stay on their parents’ health plan until the age of 26.
The plan transforms Medicare into a “premium support” model, allowing seniors to choose private health plans alongside the traditional Medicare fee-for-service program, and combines Medicare Parts A and B with a unified deductible and sets an annual maximum out-of-pocket cap on beneficiary costs. It also reforms the Medicaid program with a per-capita allotment to “reduce federal spending, but just as importantly, this Medicaid financing reform helps modernize the program by improving the incentives for states, plans, and providers to better manage dollars as they help provide care to vulnerable patients.”