10 potential changes to health care come January 20th

The new administration has already begun the process of repealing the Affordable Care Act, as Congress works to dismantle the various pieces.

Related: What comes after the ACA?

But there’s no consensus on how it’s to be done, or which parts of the law might be kept or how to pay for any provisions that remain until Republicans present a new health care plan.

There are several proposals making the rounds for the repeal/overhaul/dismantling of the law.

And, as might be expected, while there are variations among the proposals made to tackle that repeal, there are some aspects that are pretty much standard targets of successor legislation.

Some would preserve certain provisions of the ACA, add other strictures affecting payment or eligibility or do nothing less than completely repeal the law and start over.

The Transamerica Center for Health Studies has compiled four of the most prominent proposed reforms or statements from the president-elect and lawmakers and highlighted individual provisions in each.

Here are 10 of the changes these four proposals offer.

10. Repeal of the individual mandate

This change is common to the president-elect’s statement, as well as to proposals from Representative Tom Price, R-Georgia; House Speaker Paul Ryan, R-Wisconsin; and Senator Bill Cassidy, R-Louisiana.

The individual mandate was one of the biggest objections to the law by both Republicans and Democrats, as well as by groups on both sides of the political spectrum. And once enacted, it hasn’t been popular with the general public, either.

However, insurers said that without it, they would end up covering only the very ill, with the greatest dependence on medical care, without the addition of younger, healthier purchasers to offset their needs. If coverage under the ACA was to be guaranteed issue, the individual mandate was essential — and younger, healthier people would avoid purchasing coverage unless they were penalized for doing so.

But just the repeal of the individual mandate and accompanying tax penalties, according to the Committee for a Responsible Federal Budget, would add $250 billion dollars to the federal deficit over the next 10 years.

9. Change state requirements

Cassidy’s plan would require states to provide default high-deductible health insurance through a health plan with prescription drug coverage, an adequate provider network, HSA eligibility and childhood immunizations without co-pays. In addition, it would allow states to keep their current Exchange or replace it with a state plan.

8. Replace the subsidies

This change is common to the president-elect’s statement, in that he supports a full repeal of the ACA, and to proposals from Representative Tom Price, R-Georgia; House Speaker Paul Ryan, R-Wisconsin; and Senator Bill Cassidy, R-Louisiana.

But how they would do it differs. No specifics are available on Trump’s plan. Price suggests replacing current subsidies to purchase a health plan through an exchange with tax credits of $1,200 for adults and $900 per child.

Ryan would replace current subsidies to purchase a health plan through an exchange with tax incentives of $2,900 per individual or $5,700 per family for those who remain insured from plan year to plan year. And Cassidy would replace current subsidies to purchase a health plan through an Exchange with tax credits of $2,500 for adults and $1,500 per child.

7. Replace guaranteed issue

Guaranteed issue has been a boon to the many who have preexisting conditions and were previously uninsurable, but it’s on the chopping block for all four options.

While Trump supports the creation of high-risk pools for those with preexisting medical conditions, Price and Ryan would replace it with a continuous coverage provision that would prohibit insurers from denying coverage to individuals with preexisting conditions, provided that the individual remained continuously insured for the previous 18 months.

That would leave people who have a gap in coverage — perhaps because of a job loss — with no way to get coverage, if they’re unfortunate enough to have a preexisting condition.

Cassidy’s option would replace it with a continuous coverage provision mandating that insurers cover individuals with preexisting conditions, provided that the individual remained continuously insured for the previous 18 months. But he goes a step further: if continuous coverage is stopped, the individual must pay a penalty for each month without coverage up to the date of renewed coverage.

6. Allow health insurers to sell plans across state lines

Many experts have argued against this, saying that it will allow insurers to sell low-coverage policies in states where they were formerly required to provide a higher level of coverage. It is common to the Trump statement and the Price and Ryan plans.

However, Cassidy’s plan differs in that it would require no essential health benefits and would implement state-by-state minimum coverage standards.

5. Eliminate coverage of those under 26 on parents’ policies

Neither the Trump statement nor the Price and Ryan plans mention this provision of the ACA, but the Cassidy plan would require coverage of dependents up to 26 years old.

4. Omission of Essential Health Benefits requirement

Neither the Trump statement nor the Price and Ryan plans mention this provision of the ACA. The Cassidy plan, as previously mentioned, requires no essential health benefits.

3. Change how health savings accounts (HSAs) are used

While the Trump statement doesn’t mention HSAs, the Price plan would create refundable tax credits for health insurance premiums and HSA contributions, while raising the annual HSA contribution limit and placing a limit on an employer’s contribution to health coverage that can be excluded from the employee’s taxable income. This will have limited, if any, benefit for employees who already have trouble finding the money to save in an HSA.

Ryan’s plan would create new State Health Insurance Exchanges and allow participants to pay premiums with HSA funds without a tax penalty — again, a provision that will have limited benefit for those whose HSA savings don’t stretch to cover both premiums and other medical expenses.

Cassidy’s plan would require states using HSA deposit systems to provide funds into individual HSAs for health-related costs, including premiums.

2. Create high-risk pools

The Trump statement, as mentioned above, and the Price, Ryan and Cassidy plans all address state-based high-risk pools, with some differences. Trump’s plan would create high-risk pools for those with preexisting conditions, while Ryan’s and Cassidy’s would create state-based high-risk pools for those with serious medical conditions.

Price’s would partially fund reinsurance for state high-risk pools for those with serious medical conditions.

1. Repeal Medicaid expansion

While the Trump statement does not mention Medicaid expansion, repeal of this provision of the ACA — unpopular with Republican governors — is a provision in the Price and Ryan plans as follows: repealed up to 138 percent of the federal poverty level, and returned to 100 percent of FPL; in addition, the Price and Ryan plans would change funding from adjusted amounts per recipient to block grants to states.

The Cassidy plan, on the other hand, would offer optional Medicaid expansion for states.

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