Rand Paul Wants to Topple Obamacare’s House of Cards


Health policy analysts have often likened the Affordable Care Act to a house of cards; take out any portion and the whole thing tumbles. You can’t keep only some of the law.

Sen. Rand Paul (R-Ky.) this week will unveil his replacement plan for the ACA and, unlike many others, it doesn’t look to hang onto the popular parts of the health law while removing the unpopular ones. His plan would both lift the unpopular requirement that all Americans have insurance and the more-popular requirement that insurers can't deny coverage to people with pre-existing conditions. The plan, similar to those floated by House Republicans recently, would expand use of tax-advantaged health savings accounts to help people afford the cost of health services.

This replacement plan doesn't aim to protect coverage for all of the 20 million or more Americans who gained health insurance under the ACA, Paul told me recently. Instead, it looks to drive down the cost of health insurance and health services for individuals and Medicaid costs for states, he said.

“What we need to do is make available inexpensive insurance so healthy people will buy it,” Paul said.

Paul met recently with Rep. Tom Price (R-Ga.), President-elect Donald Trump's pick to head the Department of Health and Human Services, and conservative House lawmakers to discuss his ACA replacement plan. He said both House conservatives and Price were supportive of his ideas.

Paul's replacement plan tracks along the plans other conservatives have introduced in recent weeks, with some key differences. He's among those calling for the most aggressive repeal and replace timeline as well.

The far-right Republican Study Committee Jan. 4 released a replacement proposal that closely mirrors what the group put out last year. The plan, supported by Study Committee Chairman Rep. Mark Walker (R-N.C.) and Rep. Phil Roe (R-Tenn.), would fully repeal the ACA on Jan. 1, 2018, though it doesn't include a replacement timeline.

The Study Committee's bill would create a standard deduction of $7,500 for individuals and $20,500 for families, instead of using tax deductions for employer-sponsored insurance. It also would expand support for high-risk pools and allow individuals to purchase insurance across state lines.

Paul's plan would lift nearly all the ACA's major provisions and mandates, including the mandate that certain employers give their employees health insurance coverage, and would roll back requirements that define what benefits insurers must provide enrollees, known as essential health benefits.

Similar to the Study Committee's plan, Paul wants to expand health savings accounts to allow Americans to use them to pay for health insurance premiums, prescription drugs, over-the-counter medications and diet plans.

However, Paul's plan doesn't rely on high-risk pools to support people with serious and expensive health conditions. Instead, Paul said those people will likely be covered by Medicaid programs.

Paul's plan also looks to help people on the individual insurance market—typically self-employed business owners or employees of small companies—by allowing them to join associations that offer group health plans. He said this would allow insurance companies to better pool risk.

Under the ACA, low-income Americans shopping on the individual market can qualify for federal subsidies.

Read my full story at https://www.bna.com/rand-paul-plan-n73014449588/.

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