Republican Health-Care Proposals Would Reduce Coverage, RAND Finds

What would happen if Republican proposals for health-care reform are enacted? The RAND Corp. finds that, examined individually, they would reduce coverage.

However, there is room for changes that could result in keeping the 20 million coverage gains of the Affordable Care Act, RAND senior economist Christine Eibner says.

Some 252 million people have coverage under the ACA, Eibner said in a presentation at a Capitol Hill briefing. The biggest disruption in coverage would come from proposals to repeal the ACA’s Medicaid expansion and replace it with block grants to states, which would result in only 227 million people with coverage, she said.

Repealing the law and allowing health insurance sales across state lines would leave 234 million people with coverage, while repealing the ACA and enacting the Patient Choice, Affordability, Responsibility, and Empowerment (CARE) Act offered by Sens. Richard Burr (R-N.C.) and Orrin Hatch (R-Utah) and Rep. Fred Upton (R-Mich.) would result in 243 million having health-care coverage.

Different plans have been offered by Republicans just to replace the ACA’s subsidies, Eibner noted. The “Better Way” plan from House Speaker Paul Ryan (R-Wis.) would offer tax credits to people who don’t have access to employer-sponsored insurance or public programs, while the Burr-Hatch-Upton plan would provide the credits for people with incomes below 300 percent of the federal poverty level.

“So there are a bunch of different ways of doing this one piece of reform, and that’s true for pretty much all of the policies” that make up the health-care reform proposals, Eibner said.

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