House Speaker Paul Ryan and Senate Majority Leader Mitch McConnell have begun a forced march of their members toward what they hope will be the enactment of legislation repealing and replacing the Affordable Care Act (ACA). Ryan and the chairman of the key committees in the House released their initial pieces of the legislation last evening (the plan is currently broken into two parts, reflecting the jurisdiction of the two main committees, Ways and Means and Energy and Commerce). It is clear from a quick review of the plan, and from initial reactions to it from others, that the task before them remains daunting.
The initial House plan is right in a structural sense. It recognizes that, in the United States, most people under age 65 get their insurance through employers. For political and policy reasons, they cannot change this reality. What they must do, instead, is stabilize and improve the market for people who do not have access to an employer plan, starting with providing them with a tax benefit that is roughly comparable to the tax benefit conferred on employer coverage. The House plan does this by providing age-adjusted refundable tax credits to households buying insurance on their own, ranging from $2,000 to $4,000. These credits would replace the premium credits provided under the ACA, starting in 2020.