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Republican and conservative proposals to repeal the Affordable Care Act (Obamacare)

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This page covering a proposed federal healthcare bill was last updated in 2017. If you would like to help our coverage grow, consider donating to Ballotpedia. Please contact us with any updates.

On March 6, 2017, House Republicans introduced the American Health Care Act of 2017 (AHCA), a reconciliation bill that proposed modifying the budgetary and fiscal provisions of the ACA. After two canceled votes in March, the House of Representatives passed the bill 217-213 on May 4, 2017. The bill next went to the Senate for consideration. On June 22, 2017, the Senate released the Better Care Reconciliation Act of 2017 (BCRA), its version of the House bill. During the week of July 23, 2017, the Senate held a series of votes on the bill. Ultimately, the Senate did not pass the bill. For more on the Senate's effort to repeal the ACA during July 2017, click here.[1]

In his contract with American voters—the ”100-day action plan to Make America Great Again”—President Donald Trump said that he would work with Congress to repeal and replace the Patient Protection and Affordable Care Act (ACA), also known as Obamacare, during his first 100 days in office. A number of individuals and organizations have released proposals for repealing, amending, or replacing the ACA.

Because Republicans had majority control of Congress and the White House, this page summarizes Republican or conservative proposals for repealing, amending, or replacing the Affordable Care Act. It does not cover Democratic or liberal healthcare proposals that were unlikely to be passed or signed into law.

Alternative healthcare plans and sponsors
PlanSponsor(s)PlanSponsor(s)
  • American Health Care Act
    		• Kevin Brady, Greg Walden
  • After Obamacare Repeal
    		• The Heritage Foundation
  • A Better Way for Health Care
    		• Paul Ryan
  • American Health Care Reform Act
    		• Phil Roe
  • Better Care Reconciliation Act
    		• Mitch McConnell
  • Empowering Patients First Act
    		• Tom Price
  • Graham-Cassidy
    		• Lindsey Graham, Bill Cassidy
  • Health Care Choice Act
    		• Ted Cruz
  • Improving Health and Health Care
    		• American Enterprise Institute
  • Lamar Alexander's three-point plan
    		• Lamar Alexander
  • Obamacare Replacement Act
    		• Rand Paul
  • Patient CARE Act
    		• Richard Burr, Orrin Hatch, and Fred Upton
  • Universal Tax Credit Plan
    		• Avik Roy
  • World's Greatest Healthcare Plan Act
    		• Pete Sessions, Bill Cassidy

    Summary of plans

    The following table compares the features of the alternative healthcare plans highlighted on this page.

    Comparison of alternative plans to Obamacare
    Plan Repeals ACA entirely Tax credits HSAs Guaranteed issue* Insurance exchanges Interstate insurance sales Cap on untaxed benefits Medicaid block grants Ends Medicaid expansion Repeals essential health benefits
    American Health Care Act
    {{{1}}}
    {{{1}}}
    {{{1}}}
    {{{1}}}
    {{{1}}}
    {{{1}}}
    Better Care Reconciliation Act
    {{{1}}}
    {{{1}}}
    {{{1}}}
    {{{1}}}
    {{{1}}}
    {{{1}}}
    {{{1}}}
    		 **
    A Better Way
    {{{1}}}
    {{{1}}}
    {{{1}}}
    {{{1}}}
    {{{1}}}
    {{{1}}}
    {{{1}}}
    {{{1}}}
    		 †
    Patient CARE Act
    {{{1}}}
    {{{1}}}
    {{{1}}}
    {{{1}}}
    {{{1}}}
    {{{1}}}
    Empowering Patients First
    {{{1}}}
    {{{1}}}
    {{{1}}}
    {{{1}}}
    {{{1}}}
    {{{1}}}
    {{{1}}}
    Graham-Cassidy
    {{{1}}}
    {{{1}}}
    {{{1}}}
    {{{1}}}
    {{{1}}}
    {{{1}}}
    Health Care Choice Act
    {{{1}}}
    Improving Health and Health Care
    {{{1}}}
    {{{1}}}
    {{{1}}}
    {{{1}}}
    {{{1}}}
    {{{1}}}
    {{{1}}}
    {{{1}}}
    {{{1}}}
    {{{1}}}
    Universal Tax Credit Plan
    {{{1}}}
    {{{1}}}
    {{{1}}}
    {{{1}}}
    {{{1}}}
    		 Uncertain
    After Obamacare Repeal
    {{{1}}}
    {{{1}}}
    {{{1}}}
    {{{1}}}
    {{{1}}}
    {{{1}}}
    {{{1}}}
    {{{1}}}
    Lamar Alexander's three-point plan
    {{{1}}}
    {{{1}}}
    {{{1}}}
    {{{1}}}
    {{{1}}}
    World's Greatest Healthcare Plan
    {{{1}}}
    {{{1}}}
    {{{1}}}
    {{{1}}}
    {{{1}}}
    {{{1}}}
    {{{1}}}
    Obamacare Repeal Act
    {{{1}}}
    American Health Care Reform Act
    {{{1}}}
    		 ‡
    {{{1}}}
    {{{1}}}
    {{{1}}}
    {{{1}}}
    {{{1}}}
    		 §
    House Republican draft repeal bill
    {{{1}}}
    {{{1}}}
    {{{1}}}
    {{{1}}}
    {{{1}}}
    Obamacare Replacement Act
    {{{1}}}
    {{{1}}}
    {{{1}}}
    {{{1}}}
    *Note: 'Guaranteed issue' is the requirement for insurers to issue plans to all individuals, regardless of preexisting conditions.
    ** The plan would allow states to opt out of the essential benefits standards.
    † The plan would allow states that have already expanded the program to maintain the expansion, but no new states could expand the program.
    ‡ The plan would offer tax deductions rather than tax credits.[2]
    § The plan would not require the full set of 10 benefits, but would require plans to cover inpatient and outpatient care, emergency care, physician care, and catastrophic events.

    Trump Administration (first term)

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    President Donald Trump
    Vice President Mike Pence
    Cabinet • White House staff • Transition team • Trump's second term
    Policy positions
    Domestic affairs: Abortion • Crime and justice • Education • Energy and the environment • Federal courts • Firearms policy • First Amendment • Healthcare • Immigration • Infrastructure • LGBTQ issues • Marijuana • Puerto Rico • Social welfare programs • Veterans • Voting issues
    Economic affairs and regulations: Agriculture and food policy • Budget • Financial regulation • Jobs • Social Security • Taxes • Trade
    Foreign affairs and national security: Afghanistan • Arab states of the Persian Gulf • China • Cuba • Iran • Iran nuclear deal • Islamic State and terrorism • Israel and Palestine • Latin America • Military • NATO • North Korea • Puerto Rico • Russia • Syria • Syrian refugees • Technology, privacy, and cybersecurity
    Polling indexes: Opinion polling during the Trump administration

    Plans

    American Health Care Act

    See also: American Health Care Act of 2017

    The American Health Care Act was introduced in the U.S. House of Representatives by Representatives Kevin Brady (R-Texas) and Greg Walden (R-Ore.) on March 6, 2017. The House passed the bill 217-213 on May 4, 2017. The bill is a reconciliation bill, meaning it impacts the budgetary and fiscal provisions of the ACA, and does not contain a provision to repeal the law in its entirety. If enacted, it would repeal the tax penalties on individuals for not maintaining health coverage and on employers for not offering coverage. The ACA's income-based tax credits for purchasing insurance would end, as would the enhanced federal funding for states that expanded Medicaid. The bill contains its own system of tax credits, based on age rather than income, and a penalty in the form of increased premiums for individuals who do not maintain continuous coverage.[1]

    Show more

    Individual and benefit mandates
    The American Health Care Act would repeal the penalties on individuals for not maintaining health coverage and on employers for not offering coverage. Instead, the bill would require insurers to increase monthly premiums by 30 percent for one year for individuals who did not maintain continuous health insurance coverage. The bill would not repeal the ACA's requirement that insurers cover the ten essential benefits.[3]

    The bill would also maintain a ban on lifetime and annual benefit limits and insurance plans would still be required to cover preventive care at no cost to the patient.[3]

    Tax credits and health exchanges
    Starting in 2020, the bill would eliminate the ACA's income-based tax credits and subsidies. The bill would instead provide different tax credits based on age. Individuals under 30 would receive a $2,000 annual credit, which would increase by age group up to $4,000 for individuals over the age of 60. The tax credits would be available for anyone not eligible for an employer-sponsored plan or government health program, such as Medicaid.[3]

    In the meantime, the ACA's advanced premium tax credits would be increased for young individuals earning incomes above 150 percent of the federal poverty level, and decreased for older individuals earning that amount.[3]

    The health insurance exchanges would remain, as well as the open enrollment and special enrollment periods. However, tax credits could be used for plans sold on or off the exchanges; under the ACA, tax credits could only be used for on-exchange plans.[3]

    Insurance market rules
    Insurers would still be prohibited from denying coverage for pre-existing conditions or from varying premiums for individuals with such conditions. The bill would also provide $100 billion to states to establish various methods of covering particularly high-risk individuals with such conditions. Insurers would also still be required to allow dependents to remain on their parents' insurance coverage until age 26. However, insurers would be allowed to charge premiums for older individuals as much as five times higher than for younger individuals; under the ACA, premiums for older individuals could only be three times greater.[3]

    Medicaid
    The bill would officially make voluntary the ACA's Medicaid expansion, which allowed states to widen eligibility for the program to individuals earning incomes up to 138 percent of the federal poverty level. However, after 2020, the bill would not provide enhanced federal funding for such expansions, as the ACA did. States would be prohibited from expanded eligibility beyond that level.[3]

    The bill would also convert Medicaid financing from an open-ended entitlement to a per-member amount. This amount would be adjusted based on five distinct groups: elderly, blind and disabled, children, expansion adults, and other adults. It also provides $10 billion over 5 years in safety net funding for states that did not expand Medicaid.[3]

    Planned Parenthood
    The bill would also end federal funding available to states to make payments to community health centers that provide family planning, reproductive health, and related medical services and also provide abortions. This would include the nonprofit organization Planned Parenthood.[3]

    Better Care Reconciliation Act

    See also: Better Care Reconciliation Act of 2017

    The Better Care Reconciliation Act (BCRA) was released on June 22, 2017 as the Senate's version of the American Health Care Act, which was passed by the U.S. House of Representatives on May 4, 2017. The bill is a reconciliation bill, meaning it impacts the budgetary and fiscal provisions of the Affordable Care Act (ACA)—commonly known as Obamacare—and does not contain a provision to repeal the law in its entirety. The bill would repeal the individual and employer mandates, adjust the ACA's system of tax credits, and end the ACA's Medicaid expansion. Medicaid funding would also be converted from an open-ended entitlement to a per-member amount.[4]

    Show more

    Individual and benefit mandates
    The Better Care Reconciliation Act would, in effect, repeal the tax penalties on individuals for not maintaining health coverage and on employers for not offering coverage. The bill would not repeal the ACA's requirement that private insurers cover the 10 essential benefits outlined by the federal government, although states could obtain a waiver from this and other provisions (see below). The bill also does not repeal the bans on lifetime and annual benefit limits and insurance plans.[4]

    Tax credits
    Like under the Affordable Care Act, tax credits under the Better Care Act would be based on age, geography, and income. Starting in 2020, the bill would lower the upper-income threshold to qualify for tax credits from 400 percent of the poverty level to 350 percent. It would also remove the floor for tax credit eligibility—set at 100 percent of the poverty level under the ACA—meaning anyone earning incomes below 350 percent of the poverty level and ineligible for Medicaid could receive tax credits.[4]

    Tax credits could not be used for plans that cover abortions except for those necessary to save the life of the mother or in cases of rape or incest. The health insurance exchanges would remain in operation, as well as the open enrollment and special enrollment periods.[4]

    Insurance market rules and funding
    Insurers would still be prohibited from denying coverage for pre-existing conditions. Insurers would also still be required to allow dependents to remain on their parents' insurance coverage until age 26. However, insurers would be allowed to charge premiums for older individuals as much as five times higher than for younger individuals; under the ACA, premiums for older individuals could only be three times greater. The bill also ends the federal requirement that health plans spend at least 80 percent of revenue on medical costs, as opposed to administration. States would instead be required to set their own requirements for health plan spending.[4]

    Health savings accounts
    The bill would raise the annual contribution limit to health savings accounts (HSAs) to the combined amount of the deductible and out-of-pocket costs for high-deductible health plans, which is set annually by the Internal Revenue Service. In 2017, high-deductible health plans had to have deductibles of at least $1,300 for an individual or $2,600 for a family. Out-of-pocket costs were limited to $6,550 for individuals and $13,100 for families.[4][5]

    Medicaid
    The bill would also convert Medicaid financing from an open-ended entitlement to a per-member amount. This amount would be adjusted based on five distinct groups:

    • elderly individuals
    • blind and disabled individuals
    • children
    • expansion adults
    • other adults

    The law would set a target spending amount for states based on spending during a past two-year period that the state chose. The amount allotted to a state would increase each year by the medical component of the consumer price index (CPI) plus 1 percentage point until 2025, then would increase by the CPI each year thereafter. Beginning in 2020, states that spent more than the targeted amount on their Medicaid programs in any given year would receive a reduced amount of funding the following year.[4]

    Planned Parenthood
    The bill would suspend federal funding to community health centers that provide family planning, reproductive health, and related medical services and that also provide abortions. This would include the nonprofit organization Planned Parenthood. The funding would be suspended for one year.[4]

    Waivers
    The Senate bill would retain but amend the ACA's 1332 waiver program, which allowed states to obtain waivers to opt out of or amend the ACA's provisions, including, but not limited to, the essential health benefits, the health insurance exchanges, the individual and employer mandates, and the premium tax credits. The government could only grant waivers if state plans met the following conditions:[4]

    • provided coverage that was at least as comprehensive
    • provided coverage that was at least as affordable
    • provided coverage to at least a comparable number of residents
    • did not increase the federal deficit

    The Senate bill changes the conditions that states must meet for waiver approval. Under the Senate bill, states would only be required to demonstrate that their plan would not increase the federal deficit.[4]

    A Better Way for Health Care

    See also: Paul Ryan's "Better Way for Health Care" plan

    On June 22, 2016, House Speaker Paul Ryan (R-Wis.) released a white paper called A Better Way for Health Care. While the proposal was not a formal piece of legislation, Ryan said that it represented a "first-time-in-six-years consensus by the Republicans in the House on what we replace Obamacare with." The plan would primarily provide consumers with tax credits to purchase insurance and encourage the use of health savings accounts.

    Show more

    House Speaker Paul Ryan's (R-Wis.) A Better Way plan would repeal the Affordable Care Act (ACA) nearly in its entirety. The plan would maintain a ban on denying coverage for preexisting conditions, allow dependents to stay on their parent's plan until age 26, prohibit lifetime limits on coverage, and ban insurers from retroactively canceling policies. These elements were all present in the Affordable Care Act.[6]

    A Better Way also envisions some components similar to those in the ACA:

    • insurance market exchanges, though these would be privately run;
    • a limit on untaxed health benefits, though it would adjust for the cost of living;
    • and tax credits to help individuals purchase insurance, though these would be a fixed amount that grows over time, rather than tied to premiums.

    The plan emphasizes these as differences from Obamacare. A Better Way would also encourage the use of consumer-directed health plans, which pair high-deductible health plans with medical payment accounts such as health savings accounts or health reimbursement accounts. Under the plan, small businesses, voluntary organizations, and individuals would be allowed to pool together to purchase health coverage; the plan posits that this would give these groups greater negotiating power with insurance companies. Public high-risk pools would be established for individuals with costly conditions to keep them from paying high premiums.[6]

    After Obamacare Repeal

    How many GOP senators voted to repeal Obamacare?

    September 14, 2017: Commenting on the apparent change of position among Republican senators who voted against Obamacare repeal, Senator Ben Sasse (R-Neb.) claimed, “With just one exception, every member of the Republican majority already either voted for repeal or explicitly campaigned on repeal.”
    Is Sasse correct?

    Read Ballotpedia's fact check »

    See also: The Heritage Foundation's "After Obamacare Repeal" Plan

    After Obamacare Repeal is a healthcare plan released by The Heritage Foundation in October 2013. The plan would primarily provide consumers with tax credits to purchase insurance and encourage the use of health savings accounts. Employer-sponsored insurance would also be amended ending the federal tax deduction for health benefits.

    Show more

    The Heritage Foundation's After Obamacare Repeal would repeal the Affordable Care Act (ACA) in its entirety. The plan also proposes ending the federal tax deduction for health benefits offered by employers and instead offering all individuals a tax credit to purchase health insurance on their own. The plan would also support offering each American a standard tax deduction for health insurance as an alternative to tax credits.[7] Under the proposal, employers would offer their employees a cash contribution to purchase their own insurance, rather than providing health plans directly.[8]

    After Obamacare Repeal would also encourage the use of health savings accounts (HSAs) by removing the restriction on using HSA funds for health insurance premiums and by raising the limit on the amount of money an individual may deposit into the account each year. In place of the prohibition on denying coverage for preexisting conditions, the plan supports either state-operated high-risk pools or state reinsurance programs that would reimburse insurers for the cost of covering individuals with complex or expensive conditions.[8]

    With the goal of increasing competition, the proposal would remove federal barriers to selling insurance plans across state lines. Under the plan, small businesses and individuals could pool together for the purpose of purchasing insurance, and religious groups and fraternal organizations could offer insurance plans to their members.[8]

    After Obamacare Repeal would also make changes to Medicaid and Medicare. The proposal would encourage states to provide low-income Medicaid beneficiaries with cash assistance to purchase private health plans. Federal Medicaid funds would be distributed to states either through block grants or a per-capita allotment, rather than as a matching percentage of state funds. The Medicare program would be altered by allowing doctors and patients to "[contract] privately for medical services outside of traditional Medicare." The plan also supports providing Medicare enrollees with a subsidy to purchase a health plan of their choice.[8]

    American Health Care Reform Act

    See also: Phil Roe's "American Health Care Reform Act of 2017"

    The American Health Care Reform Act was introduced in January 2017 by Representative Phil Roe (R-Tenn.), a member of the Republican Study Committee. The proposal would provide individuals with a standard tax deduction for the purchase of health insurance, rather than the tax credits offered under the Affordable Care Act.[9] The bill would also encourage the use of health savings accounts and change the legal structure for medical malpractice lawsuits by placing a greater burden on patients to prove negligence.

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    Representative Phil Roe's (R-Tenn.) American Health Care Reform Act would repeal the Affordable Care Act (ACA) in its entirety. The bill would also repeal healthcare-related provisions of the Health Care and Education Reconciliation Act, which amended the ACA. The plan would maintain a ban on denying coverage for preexisting conditions, although the individual would have to maintain continuous coverage and insurers could charge them higher premiums. The bill also contains a cap on untaxed employer health benefits similar to the Cadillac tax in the ACA: benefits valued above $7,500 per year for individuals and $20,500 would be taxed as regular income.[10]

    Empowering Patients First Act

    See also: Tom Price's "Empowering Patients First Act" of 2015

    The Empowering Patients First Act was first introduced in 2009 by then-Congressman Tom Price (R-Ga.), who was confirmed as United States Secretary of Health and Human Services on February 10, 2017.[11] During his time in Congress, Price reintroduced a new version of the bill in each session. In 2015, the fourth iteration of the plan was introduced. The proposal primarily envisions a system of tax credits, health savings accounts, and individual insurance pools to expand health insurance coverage.

    Show more

    Congressman Tom Price's (R-Ga.) Empowering Patients First Act would repeal the Affordable Care Act (ACA) in its entirety. The plan would maintain a ban on denying coverage for preexisting conditions and a limit on untaxed health benefits. The plan also envisions a system of tax credits to help individuals purchase insurance, though these would be based on age and the average price of insurance for different age groups.[12]

    Like other Obamacare replacement plans proposed by Republicans, the American Health Care Reform Act would encourage the use of health savings accounts (HSAs). It would expand the list of approved withdrawals from HSAs to include monthly insurance premiums, exercise equipment, and fitness club membership fees, as well as herbs, vitamins, minerals, homeopathic remedies, and other dietary supplements. While individuals would still need a high-deductible health plan to qualify for an HSA, the bill would increase the annual HSA contribution limit to match the combined amount of the deductible and out-of-pocket limits of the health plan. In 2017, this was $7,850 for an individual and $15,700 for families.[10][13]

    Other changes to the health system include the following:[10]

    • providing $25 billion over 10 years in grants to states to maintain high-risk pools
    • allowing insurance companies to sell health plans across state lines
    • allowing small businesses to purchase health coverage for their employees through small business associations
    • applying federal antitrust laws to health insurance companies

    The American Health Care Reform Act also includes some changes to the legal structure for medical malpractice lawsuits. The law would direct a group of physicians to develop clinical guidelines. Physicians subject to a lawsuit could claim adherence to the clinical guidelines as a defense. The case would then be reviewed by an independent medical review panel, which would determine whether the physician did or did not adhere to the guidelines, and whether any failure to adhere was negligent. The results of the review could be admitted in court as evidence, and if the board found that the physician did adhere to the guidelines, they could not be held liable in a lawsuit "unless the plaintiff is able to show by clear and convincing evidence" that the board erred in judgment.[10]

    Graham-Cassidy Obamacare replacement plan

    See also: Graham-Cassidy Obamacare replacement plan

    On July 13, 2017, Senators Lindsey Graham (R-S.C.) and Bill Cassidy (R-La.) released a proposal to modify the Affordable Care Act (ACA), also known as Obamacare.[14] The plan addressed the budgetary and fiscal provisions of the ACA and did not contain a provision to repeal the law in its entirety. Instead, the plan would have kept in place most of the ACA's taxes and fees and sent that money to the states for them to make changes to health insurance and healthcare at the state level.

    An initial version of the plan was introduced as an amendment to the American Health Care Act of 2017 during the Republican effort to repeal the ACA in July 2017. The amendment did not receive a vote.[15]

    The plan was reintroduced in September 2017. Without enough votes to pass the bill, which was opposed by Republican Sens. Susan Collins (R-Maine), Rand Paul (R-Ky.), and John McCain (R-Ariz.), Senate Republicans decided on September 26, 2017, not to bring the bill to a vote.[16][17]

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    Tax credits
    The proposal would repeal the federal premium tax credits and the cost-sharing reductions provided to individuals under the ACA. States could create their own system of tax credits and subsidies if they chose. Under the proposal, tax credits using federal funds could not be used for plans that cover abortions except for those necessary to save the life of the mother or in cases of rape or incest. The plan would also eliminate the limit on the amount of overpaid tax credits the federal government can recoup.[18]

    Individual and employer mandates
    The federal requirements for individuals to obtain health insurance and for employers to offer it would be effectively eliminated by reducing the penalty to $0. States could establish their own requirements, if they chose.[18]

    Healthcare grants
    In place of federal tax credits, cost-sharing reductions, and the Medicaid expansion, the proposal would fund a grant program for states. The funds could be used to establish programs or policies to help cover high-risk individuals, stabilize premiums, and reduce out-of-pocket costs. The proposal would appropriate $1.04 trillion between 2020 and 2026 for the grant program. Funding would be allocated based on the number of low-income individuals in a state, the number of individuals between the ages of 45 and 64 in a state, the average per capita income of a state, the population density of a state, and whether a state had expanded Medicaid. States would be required to provide matching funds at an amount equal to 3 percent in 2020 and increasing to 5 percent by 2026.[18]

    Insurance market rules and funding
    Many of the ACA's insurance market rules would remain in effect. Insurers would still be prohibited from denying coverage for pre-existing conditions. Insurers would also still be required to offer a federally specified set of health benefits and to allow dependents to remain on their parents' insurance coverage until age 26. Insurers would be allowed to charge premiums for older individuals as much as five times higher than for younger individuals; under the ACA, premiums for older individuals could only be three times greater. Any individual could purchase a catastrophic health plan; under the ACA, this was restricted to individuals under 30 or those who meet a hardship exemption.[18]

    Medicaid
    The Affordable Care Act allowed states to expand eligibility for their Medicaid programs to childless adults earning incomes below 138 percent of the poverty level. The plan would end this Medicaid expansion on January 1, 2020.[18]

    The bill would also convert Medicaid financing from an open-ended entitlement to a per-member amount. This amount would be adjusted based on five distinct groups:[18]

    • elderly individuals
    • blind and disabled individuals
    • children
    • expansion adults
    • other adults

    The law would set a target spending amount for states based on spending during a past two-year period that the state chose. Until 2025, the amount allotted to a state would increase each year by the medical component of the consumer price index (CPI); for elderly individuals and blind individuals, it would increase by medical CPI plus 1 percentage point. After 2025, the amount would increase by the CPI each year. Beginning in 2020, states that spent more than the targeted amount on their Medicaid programs in any given year would receive a reduced amount of funding the following year.[18]

    Health savings accounts
    The proposal would allow individuals with high-deductible health plans to use health savings accounts (HSAs) to pay premiums in excess of amounts that are already credited or deducted through the federal tax code. The plan would also increase the limit on annual HSA contributions to the combined amount of the deductible and the limit on out-of-pocket spending. In 2017, high-deductible health plans had to have deductibles of at least $1,300 for an individual or $2,600 for a family. Out-of-pocket costs were limited to $6,550 for individuals and $13,100 for families. This means that under the plan, using 2017 figures, an individual could contribute $7,850 to an HSA each year and a family could contribute $15,700. By comparison, for 2016, these limits were capped at $3,350 for individuals and $6,750 for families.[19][18]

    Planned Parenthood
    The bill would suspend federal funding to community health centers that provide family planning, reproductive health, and related medical services and that also provide abortions for reasons other than rape or incest or to save the life of the mother. This would include the nonprofit organization Planned Parenthood. The funding would be suspended for one year.[18]

    Waivers
    The proposal would retain but amend the ACA's 1332 waiver program, which allowed states to obtain waivers to opt out of or amend the ACA's provisions, including, but not limited to, the essential health benefits, the health insurance exchanges, the individual and employer mandates, and the premium tax credits. The government could only grant waivers if state plans met the following conditions:[18]

    • provided coverage that was at least as comprehensive
    • provided coverage that was at least as affordable
    • provided coverage to at least a comparable number of residents
    • did not increase the federal deficit

    The Senate bill changes the conditions that states must meet for waiver approval. Under the Senate bill, states would only be required to demonstrate that their plan would not increase the federal deficit.

    Health Care Choice Act

    See also: Ted Cruz's "Health Care Choice Act"

    The Health Care Choice Act was introduced in Congress by Senator Ted Cruz (R-Texas) on March 3, 2015. "Every last word of Obamacare must be repealed," Cruz said in a press release. The bill would repeal only Title I of the Affordable Care Act (ACA). In place of the ACA's Title I, the Health Care Choice Act primarily envisions a system of insurers selling healthcare plans across state lines.

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    Senator Ted Cruz's (R-Texas) Health Care Choice Act would repeal only Title I of the Affordable Care Act (ACA). Title I contained most of the major reforms to the individual health insurance market, such as the individual mandate, an outline of benefits insurers must provide, and the establishment of health insurance exchanges. Titles II through X, containing provisions such as the Medicaid expansion, would remain in effect.[20]

    In place of the ACA's Title I, the Health Care Choice Act primarily envisions a system of insurers selling healthcare plans across state lines. This element is present in other alternative healthcare proposals as well, such as House Speaker Paul Ryan's (R-Wis.) A Better Way plan. Unlike these other plans, the Health Care Choice Act does not repeal the entire ACA and the plan contains only the provision to allow insurers to sell plans across state lines.[20]

    Under the Health Care Choice Act, insurers would establish a "primary state" from which to sell plans and would be required to adhere to the laws and regulations of that state. Insurers could also offer plans in other states, called "secondary states" in the plan, and—with some exceptions—would not be required to adhere to the laws and regulations of those states. Secondary states may require out-of-state insurers to

    • pay taxes on the plans they sell there,
    • register with the state's insurance commissioner,
    • submit documents regarding financial solvency,
    • comply with lawful court orders and injunctions,
    • comply with state fraud, abuse, and unfair claims laws, and
    • undergo an independent review of coverage options.

    Coverage offered in secondary states must first be offered in the insurer's primary state.[20]

    House Republican draft repeal bill

    See also: House Republican draft of Obamacare repeal bill, 2017

    A copy of a House Republican draft bill to repeal the Affordable Care Act (ACA), commonly known as Obamacare, was obtained by Politico on February 24, 2017. The bill is a reconciliation bill, meaning it impacts the budgetary and fiscal provisions of the ACA, and does not contain a provision to repeal the law in its entirety. However, the bill does repeal most of the law's taxes and fees, the penalty that enforces the individual mandate, and the financial assistance the law provides individuals to purchase health insurance.

    Show more

    The bill would repeal the penalties on individuals for not maintaining health coverage and on employers for not offering coverage. The law's advanced premium tax credits and cost-sharing subsidies that are provided to individuals to purchase insurance through the health insurance exchanges would end. Instead, the proposal would provide different tax credits based on age rather than income. Individuals under 30 would receive a $2,000 annual credit, which would increase by age up to $4,000 for individuals over the age of 60.[21][22]

    In place of the individual mandate, the bill would require insurers to increase monthly premiums by 30 percent for one year for individuals who did not maintain continuous health insurance coverage. While individuals could enroll during special enrollment periods, the bill would require proof of eligibility for special enrollment. Insurers would still be prohibited from denying coverage because of a pre-existing condition, but the bill would also provide $100 billion to states to establish various methods of covering particularly high-risk individuals with such conditions.[21][22]

    Insurers would no longer be required to offer a standard set of benefits determined by the federal government. Instead, the bill leaves it to states to decide which benefits insurers must cover. Insurers would also be allowed to charge older individuals premiums up to five times greater than younger individuals. Under the ACA, older individuals could only be charged premiums up to three times greater than younger ones.[21]

    The bill would end the ACA's Medicaid expansion, which allowed states to widen eligibility for the program to individuals earning incomes up to 138 percent of the federal poverty level. Instead, the proposal would provide states with fixed per-member funding, adjusted only for the health status of enrollees. States could still provide Medicaid coverage to their expanded eligibility level, but would not get enhanced federal funding for doing so as they did under the ACA.[22][23]

    The bill would repeal most of the ACA's taxes and fees, such as the taxes on pharmaceutical manufacturers, medical devices, health insurance plans, and tanning beds. The bill would, however, maintain a tax on premium contributions made by employers, similar to the 40 percent excise tax (called the Cadillac tax) included in the ACA. Under the draft bill, however, employer benefits above 90 percent of 2019 premium amounts would be taxed as regular income.[21][22]

    Improving Health and Health Care

    See also: American Enterprise Institute's "Improving Health and Health Care" plan

    Improving Health and Health Care is a healthcare plan released by the American Enterprise Institute (AEI) in December 2015. The proposal would maintain a ban on denying coverage for preexisting conditions, a limit on untaxed health benefits, and tax credits for individuals to purchase insurance. Unlike other repeal and replace healthcare plans, the AEI proposal envisions keeping the health insurance exchanges, although these could be privately run.

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    The American Enterprise Institute's Improving Health and Health Care plan would repeal the Affordable Care Act (ACA) in its entirety. In its place, the plan envisions some components similar to those in the ACA:[24]

    • insurance market exchanges, though these could be privately run;
    • a ban on denying coverage for preexisting conditions, for those who have maintained continuous coverage;
    • a limit on untaxed health benefits, though benefits above the limit would be taxed as taxable income, rather than with a 40 percent excise tax; and
    • tax credits to help individuals purchase insurance, though these would be based on age, rather than on income.

    Under the plan, individuals eligible for the tax credit who do not select a plan could be enrolled by default in plans designated by states. States could establish public high-risk pools for individuals with costly conditions who have not maintained continuous coverage. The plan would encourage the use of health savings accounts (HSAs) by offering a one-time tax credit for deposit in an HSA and raising the annual contribution limit. HSAs would also be included in Medicaid and Medicare program designs.[24]

    The proposal also envisions allowing states to keep their health insurance exchanges, though regulations imposed by the exchanges on health plans would be removed. Private organizations could also establish exchanges to compete with the state-run platforms. The plan also proposes allowing the code for the federal exchange Healthcare.gov to be open source, meaning anyone could copy it. With the idea of encouraging competition between insurance companies, Improving Health and Health Care would allow insurance companies to sell health plans across state lines.[24]

    Improving Health and Health Care would also make changes to Medicaid and Medicare. Federal funding for Medicaid would be fixed, and funds would be distributed to states through block grants. The plan specifies that increases in Medicaid costs would be financed with state funding, rather than with federal funding. Medicaid enrollees could choose whether to remain in Medicaid or private plans, with the help of the tax credit and state funding. State efforts to transition elderly Medicaid enrollees out of nursing home care and into home-based care would be encouraged.[24]

    The Medicare program would be altered by offering beneficiaries premium assistance subsidies to purchase competing health plans, which would include traditional Medicare. Beneficiaries who did not select a plan would be enrolled by default in a private plan. The plan would combine Medicare Parts A and B, which cover hospitalization and physician and outpatient services, respectively, and would vary beneficiary cost-sharing by income. Beneficiaries would be required to make a minimum out-of-pocket payment without using supplemental coverage. Finally, the plan would divide traditional Medicare into regional plans and raise the Medicare eligibility age to 67.[24]

    Lamar Alexander's three-point plan

    See also: Lamar Alexander's three-point Obamacare repeal-and-replace plan

    On January 12, 2017, Senator Lamar Alexander (R-Tenn.) proposed a three-point health plan for repealing and replacing the Affordable Care Act, commonly referred to as Obamacare. The plan advocates for repealing Obamacare only once a replacement plan is in place. With the intent of easing the transition between Obamacare to a new system, the plan would allow individuals to use their tax credits to purchase plans off the exchanges and allowing Obamacare's cost-sharing reduction measures to continue temporarily.[25]

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    In the longer term, states would be allowed to determine the minimum essential health benefits that plans must cover, expand the use of health savings accounts, and repeal the individual mandate. Children would still be allowed to remain on their parents' health plan until age 26 and the ban on denying coverage for pre-existing conditions would be maintained.

    Obamacare Repeal Act

    See also: Mo Brooks' "Obamacare Repeal Act"

    The Obamacare Repeal Act was introduced by Representative Mo Brooks (R-Ala.) on March 24, 2017, the same day the American Health Care Act of 2017 was pulled from consideration before a scheduled vote. The bill contained two provisions, each one sentence long, to repeal the Affordable Care Act and the Health Care and Education Reconciliation Act. The bill did not contain any measures to replace the ACA's provisions.

    Obamacare Replacement Act

    See also: Sen. Rand Paul's "Obamacare Replacement Act"

    The Obamacare Replacement Act was introduced by Senator Rand Paul (R-Ky.) on January 24, 2017. The bill would repeal major provisions of the Affordable Care Act, commonly known as Obamacare, though it would not repeal the law in its entirety. The individual and employer mandates, essential health benefits mandate, and various other provisions impacting the insurance industry would be repealed. The bill would provide for a $5,000 tax credit for contributions to a health savings account and a tax deduction for the purchase of an individual plan, similar to the deduction for employer-sponsored benefits. Instead of an individual mandate to increase insurance coverage, the bill would allow individuals to pool together to purchase plans.

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    Under the act, insurers would no longer be prohibited from denying coverage to individuals with pre-existing conditions. Instead, such individuals would be given two years to enroll in a health plan, and thereafter would only be protected from a denial of coverage if they maintain continuous coverage. Individuals with pre-existing conditions would still be able to obtain coverage at any time in the group, or employer, market, as they've been able to since the passage of HIPAA.[26]

    The bill would expand the use of HSAs by making several changes to their legal structure. Under the bill, annual contributions to an HSA would no longer be capped and the accounts would no longer be tied to high-deductible health plans. Account owners would be able to withdraw funds to purchase prescription and over-the-counter medications, health insurance premiums, exercise equipment, dietary and nutritional supplements, and physical fitness programs, which previously have not been allowable expenses. The bill would also protect HSA funds in the event of bankruptcy.[27]

    The bill includes a few provisions intended to expand access to health insurance coverage. Under the proposal, insurers could sell policies across state lines. The bill would also allow individuals to pool together to purchase health coverage. Coverage could also be offered by nonprofit entities such as churches or alumni associations. The bill would also amend regulations regarding association health plans, which allow small businesses to pool together across state lines through trade or professional associations in order to purchase coverage. The plan would allow association health plans to be treated as large group, employer-sponsored, self-insured plans.[27]

    Patient CARE Act

    See also: Senators Burr, Hatch, and Upton's "Patient CARE Act"

    The Patient Choice, Affordability, Responsibility, and Empowerment (CARE) Act was introduced in the United States Senate Finance Committee by Senators Richard Burr (R-N.C.), Orrin Hatch (R-Utah), and Fred Upton (R-Mich.) in 2015. The plan is similar to Rep. Paul Ryan's (R-Wis.) A Better Way plan. Key differences include auto-enrollment of individuals in default health plans and higher tax credits for those with lower incomes.

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    Senators Richard Burr (R-N.C.), Orrin Hatch (R-Utah), and Fred Upton's (R-Mich.) Patient Choice, Affordability, Responsibility, and Empowerment (CARE) Act would repeal the Affordable Care Act (ACA) nearly in its entirety. The plan would prohibit lifetime limits on coverage, cap untaxed health benefits, and ban insurers from retroactively canceling policies. These elements were all present in the Affordable Care Act.[28]

    The Patient CARE Act also envisions some components similar to those in the ACA:[28]

    • a ban on denying coverage for preexisting conditions, although if the individual had not maintained continuous coverage, they could be charged higher premiums;
    • allowing dependents to stay on their parent's plan until age 26, although a state could opt-out;
    • requiring insurance companies to disclose to enrollees information regarding benefits and coverage; and
    • a tax credit for individuals and employees at small businesses to purchase insurance, although the credit would only be available up to 300 percent of the federal poverty level.

    The proposal would create a health financing office within the U.S. Treasury Department to administer the tax credit, which would undergo compliance reviews by the Treasury Inspector General. Individuals who are eligible for a tax credit but do not choose a health plan could be automatically enrolled in a default health plan by the state, which they could later change or cancel altogether. The plan encourages the use of consumer-directed health plans, which pair high-deductible health plans with medical payment accounts such as health savings accounts or health reimbursement accounts.[28]

    Under the Patient CARE Act, states would be allowed to form high-risk pools with federal funding for individuals with chronic and complex conditions. Small businesses could pool together to purchase health coverage, and states could form interstate compacts for the purpose. The plan would also reduce federal barriers to purchasing coverage across state lines.[28]

    Universal Tax Credit Plan

    See also: Avik Roy's "Universal Tax Credit Plan"

    The Universal Tax Credit Plan was released by conservative healthcare policy writer Avik Roy in 2016. Unlike other conservative proposals, the plan argued against repealing the Affordable Care Act, commonly known as Obamacare, in its entirety. The plan would maintain a system of tax credits and encourage the use of high-deductible health plans and health savings accounts. It would also lower restrictions on the premium rates and benefits that insurers must offer.

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    Avik Roy's (R-Wis.) Universal Tax Credit Plan proposes a series of changes to the individual health insurance market, Medicare, and Medicaid. The plan is against a full repeal of the Affordable Care Act (ACA), arguing that a repeal would not receive the number of votes needed to pass and would disrupt health coverage in the individual market.[29]

    The plan would maintain the ACA's ban on denying coverage for preexisting conditions, the law's four metal tiers of coverage (bronze, silver, gold, and platinum), and its prohibition on annual and lifetime coverage limits. A system of health insurance exchanges would remain in place, although these would not necessarily be state-run. The proposal would also preserve some of the ACA's premium rating restrictions by requiring insurers to charge the same premium amount regardless of gender or health status. Premiums could vary by age at a ratio of 6 to 1, meaning the oldest enrollees could be charged six times the premium amount of the youngest enrollees; the ACA's age rating ratio is 3 to 1. The plan also involves tax credits based on income, similar to those in the ACA, but limited to individuals earning incomes at or below 317 percent of the federal poverty level.[29]

    Under the Universal Tax Credit Plan, the ACA's individual mandate would be repealed. Open enrollment for plans on the exchanges would occur for six weeks every two years, rather than annually as under the ACA. Individuals who did not select a plan during open enrollment would not be fined, but would not be protected from preexisting coverage denials or higher premiums. States could automatically enroll residents into a default health plan if they do not select one during open enrollment.[29]

    The Universal Tax Credit Plan would encourage the use of consumer-directed health plans (CDHPs), which pair high-deductible health plans with health savings accounts (HSAs). The benchmark plan offered on the exchanges would be a CDHP with an annual deductible of $7,000 for individuals and $14,000 for families. Individuals with incomes below 250 percent of the federal poverty level would receive an extra tax subsidy to deposit in their HSA. The proposal would allow for greater flexibility in the ACA's "essential health benefits" that insurers are required to cover, lower the percentage of health costs that plans on the exchanges are required to offer, and repeal many of the ACA's taxes. The plan argues that these changes would lower premiums.[29]

    The proposal would maintain the ACA's 40 percent excise tax on high-value health plans, known as the Cadillac tax. However, it would repeal the requirement that employers with 50 or more employees offer health coverage. Small employers would be able to pool together for the purposes of purchasing health insurance.[29]

    The Universal Tax Credit Plan would also make changes to Medicaid and Medicare. The plan would seek to transition Medicaid enrollees who only need Medicaid for short episodes of care off Medicaid and into the individual market. For long-term care, the proposal would transfer full funding and administrative responsibility to states. Individuals who are dual-eligible for both Medicaid and Medicare would also be transitioned to the individual market.[29]

    Under the plan, the Medicare eligibility age would raise by four months annually, a policy that would continue indefinitely. Medicare Parts A and B, which cover hospitalization and physician and outpatient services, respectively, would be combined under one deductible. Medicare enrollees could also opt out of the program and enroll in private coverage instead. The proposal would also amend veterans' healthcare by allowing veterans to enroll in private health coverage, with federal financial support to cover premiums.[29]

    World's Greatest Health Plan

    See also: Cassidy-Sessions' "World's Greatest Healthcare Plan Act of 2016"

    The World's Greatest Healthcare Plan Act of 2016 was introduced by Rep. Pete Sessions (R-Texas) and Sen. Bill Cassidy (R-La.) in May 2016 as a plan for replacing the Affordable Care Act (ACA), commonly referred to as Obamacare. Unlike many other Republican healthcare plans, the World's Greatest Healthcare Plan Act would not repeal the Affordable Care Act in its entirety; the health insurance exchanges would be left in tact. The plan would, however, repeal the individual and employer mandates, two of the primary provisions in the ACA. Individuals could choose to enroll in health plans outside of the exchanges and receive a $2,500 annual tax credit to pay monthly premiums.

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    The plan would maintain a ban on annual and lifetime limits on coverage, allow adult children to remain on their parents' health plan until age 26, and maintain a ban on denying health coverage to those with preexisting conditions. These elements were all present in the Affordable Care Act. The bill would also allow the health insurance exchanges to remain in place for insurers to sell plans.[30]

    In place of the individual mandate, the bill would impose a late enrollment penalty on individuals who have not held continuous health coverage over the previous 12 months. This penalty would come in the form of higher premiums for coverage. States would be allowed to automatically enroll uninsured individuals in a default high-deductible health plan and open a health savings account (HSA) for them; individuals could opt-out of both.[30]

    Under the World's Greatest Healthcare Plan Act, health insurance plans would no longer be required to offer a standard set of benefits determined by the federal government. While advanced premium tax credits as they were established under the Affordable Care Act would remain, the Worlds Greatest Healthcare Plan Act would also offer a universally-available tax credit to purchase plans off the exchanges or deposit in an HSA. The tax credit would amount to $2,500 per individual per year, with an additional $1,500 per child.[30]

    To encourage the use of health savings accounts, the plan would raise the annual cap on contributions from $3,350 to $5,000 for individuals. For family coverage, the cap is multiplied by the number of family members covered by the policy. In addition, individuals would no longer have to be enrolled in a high-deductible health plan in order to qualify for a health savings account.[30]

    The World's Greatest Healthcare Plan Act would also make some changes to Medicaid. Under the proposal, states may choose to allow individuals enrolled in Medicaid to opt to enroll instead in a private health plan. If the state chooses to allow this option, it must provide the individual with a health savings account and deposit into the account the difference between the $2,500 tax credit and the amount it cost to cover the individual through Medicaid. Such individuals could also claim the full $2,500 universal tax credit from the federal government. The plan would also block-grant Medicaid funding to states, adjusted for four different categories of enrollees:[30]

    • Individuals age 65 and older
    • Blind or disabled individuals
    • Children under age 21
    • Other adults

    Possible administrative actions

    The Trump administration does not necessarily need to wait for a bill to be passed through Congress to make changes that impact the way the Affordable Care Act works. It could take a series of regulatory or executive actions on how the law is administered.

    Cost-sharing subsidies

    See also: Boehner's lawsuit against the Obama administration

    In November 2014, the U.S. House of Representatives filed a lawsuit against the Obama administration for its payments to insurance companies for cost-sharing subsidies, which reimburse insurers for the reductions in cost-sharing responsibilities that they provide low-income consumers under the law. Such reductions are only available to individuals who purchase plans through the health insurance exchanges. The administration had made payments totaling about $3 billion dollars in fiscal year 2014. The House argued that the administration unconstitutionally made these payments without an express appropriation from Congress.[31]

    In September 2015, the U.S. District Court for the District of Columbia ruled that the House could proceed with its lawsuit. In May 2016, the same district court ruled that the executive branch could not use unappropriated funds to subsidize insurance companies. The ruling was stayed to allow for appeal.[32][33]

    When President Donald Trump took office, his administration took responsibility for defending the cost-sharing subsidies in court. The administration could decide to drop the appeal, preventing continued cost-sharing reimbursements to insurers. However, insurers would still be required by the law to provide the discounts to consumers; one potential consequence of such an action by the Trump administration is that more insurers could decide to discontinue participation on the health insurance exchanges.[34]

    Individual mandate
    Under the ACA, individuals were required to purchase and maintain continuous insurance coverage, or otherwise be subject to a tax penalty. This was known as the individual mandate. While the mandate is written into law and cannot be changed without congressional action, the administration is responsible for enforcing it, and it could decide not to. This would mean that the Internal Revenue Service (IRS) could decide not impose a tax penalty on individuals without health insurance. The administration could also could broaden the reasons under which an individual may apply for a hardship exemption from the individual mandate, through which individuals under difficult circumstances such as bankruptcy may apply for relief from the tax penalties associated with the individual mandate.[35]

    Essential health benefits
    The ACA defined a set of ten categories of health benefits it considered essential that every health plan was required to cover:

    • Ambulatory patient services
    • Emergency services
    • Hospitalization
    • Maternity and newborn care
    • Mental health and substance abuse disorder services, including behavioral health treatment
    • Prescription drugs
    • Rehabilitative and habilitative services and devices
    • Laboratory services
    • Preventive and wellness services and chronic disease management
    • Pediatric services, including oral and vision care

    The specific benefit requirements were determined by a benchmark plan selected by each state. The benchmark plan must have been a plan offered in the small group market in that state prior to the ACA that covered benefits falling into each of the ten essential categories. The Trump administration could, through changes in regulation, grant states more flexibility in which plans they determine to be their benchmark plans. The administration could also alter the definitions of each category, which could impact which services may be included or excluded.[36]

    Political background on the ACA

    In 2010, the ACA passed Congress with only Democrats voting in favor of the bill. Although Democratic lawmakers have expressed a desire to fix parts of the law, they strongly oppose any effort to repeal the ACA. Republicans have attempted to repeal or change the ACA on multiple occasions but have been unsuccessful. They see Republican-control of the White House and both chambers of Congress as their best opportunity to repeal and replace the law.[37][38]

    Supporters of the law, such as House Minority Leader Nancy Pelosi (D-Calif.), say that healthcare is a right, which the ACA helps guarantee. Pelosi, who was integral in getting the law passed, said, “[T]he Affordable Care Act was designed to protect Americans from rate increases by ensuring that tax credits go up as premiums rise, and by empowering consumers to shop around for the best plan in competitive marketplaces. Because of this landmark law, the uninsured rate has fallen to historic lows and health care costs are growing at the slowest rate in 50 years. Children, women, workers and families across the country have newfound health and economic security thanks to the ACA. With the Affordable Care Act, we have made monumental progress toward ensuring that health care is a right, not a privilege, for all Americans. The Affordable Care Act is working, and it will continue to work in spite of Republicans’ ceaseless attempts to strip health care from millions of hard-working families.”[39]

    Critics of the ACA, such as Senate Majority Leader Mitch McConnell (R-Ky.), say that the law is fundamentally flawed and that the exchanges are poorly designed. They say that the regulations embedded in the law made health insurance expensive and unattractive to young, healthy people and that provisions intended to keep premiums affordable and maintain an optimal mix of healthy and sick enrollees have not worked. Critics also contend that the law has worsened the quality of care by disrupting the doctor-patient relationship.[40]

    News feed

    The link below is to the most recent stories in a Google news search for the terms Obamacare repeal replace plans. These results are automatically generated from Google. Ballotpedia does not curate or endorse these articles.

    Republican and conservative proposals to repeal the Affordable Care Act (Obamacare) - Google News

    See also

    Footnotes

    1. ↑ 1.0 1.1 Reuters, "U.S. House passes healthcare bill in big win for Trump," May 4, 2017
    2. ↑ Tax deductions lower the amount of an individual's taxable income, while tax credits reduce the amount of tax an individual owes.
    3. ↑ 3.0 3.1 3.2 3.3 3.4 3.5 3.6 3.7 3.8 House Energy and Commerce Committee, "Budget Reconciliation Legislative Recommendations Relating to Repeal and Replace of the Patient Protection and Affordable Care Act," accessed March 7, 2017
    4. ↑ 4.0 4.1 4.2 4.3 4.4 4.5 4.6 4.7 4.8 4.9 Senate Committee on the Budget, "Better Care Reconciliation Act of 2017," accessed June 22, 2017
    5. ↑ Willis Towers Watson, "IRS announces 2017 limits for HSAs and HDHPs," May 11, 2016
    6. ↑ 6.0 6.1 Speaker of the House, "A Better Way," accessed November 22, 2016
    7. ↑ Note: Tax credits lower an individual's amount of tax liability dollar for dollar; for example, an individual with a $100 tax credit would owe $100 less in taxes. Tax deductions lower an individual's amount of taxable income; for example, an individual making $35,000 per year with a $1,000 tax deduction would owe taxes on only $34,000 of his or her annual income.
    8. ↑ 8.0 8.1 8.2 8.3 The Heritage Foundation, "After Repeal of Obamacare: Moving to Patient-Centered, Market-Based Health Care," October 31, 2013
    9. ↑ Tax deductions lower the amount of an individual's taxable income, while tax credits reduce the amount of tax an individual owes.
    10. ↑ 10.0 10.1 10.2 10.3 Congressman Mark Walker, "American Health Care Reform Act of 2017," accessed February 8, 2017
    11. ↑ The New York Times, "Tom Price Is Confirmed as Health Secretary," February 10, 2017
    12. ↑ Congressman Tom Price, "Empowering Patients First Act," accessed November 27, 2016
    13. ↑ Willis Towers Watson, "IRS announces 2017 limits for HSAs and HDHPs," May 11, 2016
    14. ↑ CNN, "First on CNN: Graham, Cassidy unveil details of alternative health care plan," July 13, 2017
    15. ↑ Congress.gov, "H.R.1628 - American Health Care Act of 2017," accessed January 2, 2020
    16. ↑ The Hill, "Senate won't vote on ObamaCare repeal bill," September 26, 2017
    17. ↑ Politico, "Inside the life and death of Graham-Cassidy," September 27, 2017
    18. ↑ 18.0 18.1 18.2 18.3 18.4 18.5 18.6 18.7 18.8 18.9 Cite error: Invalid <ref> tag; no text was provided for refs named billtext
    19. ↑ Willis Towers Watson, "IRS announces 2017 limits for HSAs and HDHPs," May 11, 2016
    20. ↑ 20.0 20.1 20.2 U.S. Senator for Texas Ted Cruz, "Health Care Choice Act," accessed November 29, 2016
    21. ↑ 21.0 21.1 21.2 21.3 Politico, "Exclusive: Leaked GOP Obamacare replacement shrinks subsidies, Medicaid expansion," February 24, 2017
    22. ↑ 22.0 22.1 22.2 22.3 Politico, "Discussion Draft," accessed March 1, 2017
    23. ↑ PBS News Hour, "5 takeaways from the leaked Republican bill to repeal Obamacare," February 26, 2017
    24. ↑ 24.0 24.1 24.2 24.3 24.4 American Enterprise Institute, "Improving Health and Health Care," accessed December 1, 2016
    25. ↑ Lamar Alexander, "Alexander Votes to Take First Step Toward Repealing Obamacare, Building Better Health Care Systems," January 12, 2017
    26. ↑ Senator Rand Paul, "The Obamacare Replacement Act (S. 222)," accessed March 21, 2017
    27. ↑ 27.0 27.1 Cite error: Invalid <ref> tag; no text was provided for refs named obamacarereplace
    28. ↑ 28.0 28.1 28.2 28.3 United States Senate Committee on Finance, "The Patient Choice, Affordability, Responsibility, and Empowerment Act," accessed November 22, 2016
    29. ↑ 29.0 29.1 29.2 29.3 29.4 29.5 29.6 Cite error: Invalid <ref> tag; no text was provided for refs named universaltaxcredit
    30. ↑ 30.0 30.1 30.2 30.3 30.4 Congress.gov, "H.R.5284 - World's Greatest Healthcare Plan Act of 2016," accessed January 30, 2017
    31. ↑ The Wall Street Journal, "U.S. House of Representatives v. Burwell Complaint," accessed April 3, 2017
    32. ↑ Washington Post, "House of Representives Prevails In Obamacare Suit," May 12, 2016
    33. ↑ Washington Post, "House GOP can pursue part of healthcare lawsuit, judge rules," September 10,2015
    34. ↑ NPR, "How A President Trump Could Derail Obamacare By Dropping Legal Appeal," November 9, 2016
    35. ↑ Fortune, "Trump May Not Enforce Individual Health Insurance Mandate," January 22, 2017
    36. ↑ NPR, "6 Changes The Trump Administration Can Still Make To Obamacare," March 29, 2017
    37. ↑ GovTrack, "H.R. 3590 (111th): Patient Protection and Affordable Care Act," December 24, 2009
    38. ↑ GovTrack, "H.R. 3590 (111th): Patient Protection and Affordable Care Act," March 21, 2010
    39. ↑ Pelosi.House.gov, "Pelosi Statement on HHS Report Showing Continued Affordability of ACA Marketplace Health Coverage," accessed November 28, 2016
    40. ↑ RepublicanLeader.Senate.gov, "McConnell: Obamacare is failing the Middle Class," accessed November 28, 2016
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