In a display of the permanent imprint the Patient Protection and Affordable Care Act (PPACA) has had on U.S. health care and politics, even Republicans are proposing to maintain some of its key provisions as they discuss repealing and replacing the landmark health law.
A bill introduced by Reps. Bill Cassidy, R-LA, and Pete Sessions, R-TX, would allow states to "opt out" of the PPACA.
"A state can choose. They can stay in Obamacare if they want, or they can join the World Greatest Health Care Plan," Cassidy told the Washington Times.
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It would undermine the PPACA insurance marketplace by eliminating the requirement the individual and employer insurance mandate. It also reduces the mandates on what every insurance plan must cover or include.
The centerpiece of the plan would be a $2,500 tax credit aimed at helping individuals buy insurance. And it would turn Medicaid into a block grant program, with states getting a set amount of money to finance health care for their low income residents.
But the law would maintain the PPACA's prohibition on insurers discriminating against consumers based on preexisting conditions. Skeptics will no doubt argue that that provision is untenable without an insurance mandate that brings many young, healthy consumers into the marketplace who might otherwise forgo insurance. They help offset the cost of those with preexisting conditions.
Critics also point out that $2,500 is not nearly enough to help the poor buy health care if they don't qualify for Medicaid.
It is not particularly surprising that the Republican proposal maintains the preexisting conditions provision, which has proven to be one of the most popular aspects of Obamacare among the public.
But what is notable is that the GOP bill also maintains many of the PPACA tax increases. Obamacare implemented a number of measures to raise revenue to pay for the current system, including a hike in taxes on tobacco, investment income and an increase in the Medicare payroll tax.
Speaker Paul Ryan has signaled that he is currently drafting another health care bill that likely aims for a more dramatic reversal of the status quo.
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