A busy week in Washington, D.C. ended today with the inauguration of President-elect Donald Trump. Throughout his campaign and consistently after being elected, Trump has vowed to repeal and replace the Affordable Care Act (ACA) as one of his first acts in office. Last weekend, Trump announced that his replacement plan includes “healthcare for everyone”, but offered no details on how that would work.

So, what do we know at this point when it comes to the Affordable Care Act replacement? Well, we know nothing is certain and that any of the four main GOP proposals set forth at this point would be unlikely to pass in their current state. But, let’s take a quick look at the highlights of the current proposals to see where we may be heading.

House GOP Leadership
BETTER WAY FOR HEALTH CARE

  • Individual mandate: Repeal and replace it with a continuous coverage requirement.
  • Essential health benefits: This plan eliminates the coverage standards.
  • Pre-existing condition clause: As long as you maintain continuous coverage, you do not have to go through underwriting.
  • Subsidies: Estimated to be smaller than what the ACA offers and would be based on age.
  • Rates based on age: Rates could be up to five times higher for the older population.

Sen. Orrin Hatch (R-Utah)
PATIENT CARE ACT

  • Individual mandate: Repeal and replace it with a continuous coverage requirement; create a low-benefit ‘default’ health plan where uninsured people would get coverage funded by the government.
  • Essential health benefits: This plan eliminates the coverage standards.
  • Pre-existing condition clause: If an individual has gone without coverage during the previous 18 months, there is no premium cap and they could be denied coverage altogether.
  • Subsidies: Estimated to be smaller than what the ACA offers and would be based on age and income.
  • Rates based on age: Rates could be up to five times higher for the older population.

Rep. Tom Price (R-Ga)
EMPOWERING PATIENTS FIRST ACT

  • Individual mandate: Repeal and replace it with a continuous coverage requirement.
  • Essential health benefits: This plan eliminates the coverage standards.
  • Pre-existing condition clause: If an individual has gone without coverage during the previous 18 months, they could be charged up to 150% of the normal premium for two years because of their pre-existing conditions.
  • Subsidies: Estimated to be smaller than what the ACA offers and would be based on age.
  • Rates based on age: No limit to what insurers could charge based on age.

Sen. Ted Cruz (R-Texas)
HEALTH CARE CHOICE ACT

  • Individual mandate: Repeal the mandate, with no coverage requirement.
  • Essential health benefits: This plan eliminates the coverage standards.
  • Pre-existing condition clause: No protection for individuals with pre-existing conditions.
  • Subsidies: No subsidies would be offered.
  • Rates based on age: No limit to what insurers could charge based on age.

Senators Susan Collins (R-Maine), Bill Cassidy (R-La) and Rand Paul (R-Ky) have also announced this week that they are in the process of putting forth recommendations on replacement plans.

It’s also worth noting that while the ACA aimed to provide Americans with universal coverage, the Republicans have said they want to provide universal access, which could cause a dramatic downswing in coverage. It is a good thing, though, that there are multiple conversations happening around how to improve the individual market in the long-term, and we can hope that a resolution will be reached that will make coverage financially sustainable for both individuals as well as payers.