While Ryan’s plan, dubbed “A Better Way,” would keep the Obamacare provision making it unlawful for insurers to deny health coverage to people with pre-existing conditions and allow children to remain on their parents' coverage until the age of 26, it would explore the possibility of increasing competition among insurers by allowing people to purchase insurance across state lines.
The Ryan plan would also allow individuals to put money into health savings accounts, which the proposal would expand, and give block grants to states for administering Medicaid to the poor.
Additionally, Ryan proposes a gradual increase to the Medicare eligibility age (currently 65) to 67 for individuals born in 1960 or later, making the eligibility age correspond with that of the Social Security pension plan.
Also included in the plan is a refundable tax credit for people without employer-based insurance coverage, differing from Obamacare, which offers subsidies to certain individuals from lower-income families who don’t qualify for Medicaid.
“It’s better than not doing anything,” Thomas Miller, resident fellow at the American Enterprise Institute (AEI), told Patient Daily. “It’s short of a fleshed out plan that you could be voting on or being accountable for, or making some of the harder trade-offs that’s often the nature of the process.”
Given other political factors, Miller said there are many reasons why the plan hasn’t progressed to the voting stage, including the barriers to repealing elements of Obamacare enacted six years ago.
There are some aspects that are sometimes overlooked when legislators don’t actually have to add specifics to a plan, which is required for voting on an issue.
“I don’t want to say that that’s unusual because we’ve seen that happen in Congress before,” Miller said. “And the Speaker has a difficult task of uniting all different factions of the Republican House, which involves straddling over some different positions. So it’s an achievement to have them thinking they’re all agreeing to the same thing. It’ll be a bigger achievement if they can actually vote for it and put it into law, but one step at a time.”
Miller said he believes Ryan has introduced the concept of having the ability to have more options in purchasing health care in exchange for consumers making better choices.
“We’ll have to see how that trade-off works and whether you can get a substantial majority in favor of it as opposed to the devil they know with various restrictions and subsidies and rules and limitations of what we have right now,” he said.
Similar to the Cadillac tax applied to expensive employer-based health care plans under Obamacare, Ryan’s proposal would place a cap on the tax deductibility of employer plans.
Medical liability reform placing a cap on non-economic damages awarded in lawsuits, which aims to cut health care costs as a whole, is also proposed in Ryan’s plan, in addition to giving states that chose to expand the number of people eligible for Medicaid under Obamacare the freedom to keep the expansion. Ryan’s plan, however, would not permit states wishing to expand Medicaid this year to do so.
“Normally this type of campaign election year policy development comes from the presidential candidate," Miller said. "It reflects the lack of that in this current campaign that the House is filling that gap. The Speaker (should be) given credit for doing that so that someone is keeping these issues alive and thinking about where (they want the issues to go).”