Moving to follow through on their party's pledge to repeal and replace the Obama health law, Republicans in the House of Representatives on Monday evening unveiled their first full legislative plan on health care, which would pull back on the federal government's role in the health care arena, though the GOP issued no official estimates on the cost of the changes.
"Obamacare is rapidly collapsing," said Speaker Paul Ryan in a written release issued minutes after the GOP bill language was posted on the internet.
"It’s time to turn a page and rescue our health care system from this disastrous law," the Speaker added.
The GOP plan has been dubbed, "The American Health Care Act."
The plan would essentially do away with the individual and employer mandates that required health care coverage; Republicans are proposing a new system to help people buy insurance, with refundable tax credits:
While the individual and employer mandates are effectively repealed by this legislation, there will be one provision that seems likely to draw opposition, as it would levy a 30 percent surcharge on premiums, if you have gone more than two months without health insurance coverage, but try to go back in to get coverage.
Here is that section of the bill:
The lack of coverage mandates swiftly drew criticism.
"This will create a less diverse risk pool, driving up rates for sicker, older individuals that do purchase coverage," said Mara Baer, once a lobbyist for the insurance industry.
"A costly continuous coverage surcharge will only exacerbate this problem by encouraging healthy people to enter the market only when they desperately need care," Baer added.
No cost estimates were issued by Republicans or by the Congressional Budget Office on this plan, leaving an important question unanswered - how much will the bill cost?
This was the GOP answer on Monday night:
As one might imagine, reaction was varied as experts on all sides tried to digest what the GOP plan would do.
"There are some fragile insurance markets under the ACA," said Larry Levitt of the Kaiser Family Foundation. "The question is whether the House bill stabilizes these markets or makes them worse."
"This new health bill seems great if you're a hospital, a millionaire with insurance, or a fan of adverse selection," said Zack Cooper, a health economist at Yale University.
The GOP plan, while a change from the Obama health law, is certainly not a full repeal of the former President's plan.
Levitt says the new bill would retain the ban on any lifetime or annual benefit limits on benefits being placed on consumers; it also leaves in place other consumer protections put there like guaranteed access and community ratings for health insurance pricing.
The plan would cut the amount of money going to states under Medicaid - that's certain to be controversial within Republican ranks.
"We are concerned that any poorly implemented or poorly timed change in the current funding structure in Medicaid could result in a reduction in access to life-saving health care services," four GOP Senators wrote in a letter, led by Sen. Rob Portman (R-OH).
While most Republicans held their fire on the new GOP plan, or complained about individual issues, not all lawmakers did that.
"Obamacare 2.0," fumed Rep. Justin Amash (R-MI).
"Bottom line, what we are starting to see take shape is not a repeal and that is the major issue in front of us," said Rep. Dave Brat (R-VA).
Conservative groups didn't like how some of the taxes levied under the Obama health law would live for an extra year, and one - the so-called "Cadillac tax" on expensive health insurance plans - would not be repealed, only delayed until 2025.
Two different House committees will vote on different portions of the bill this Wednesday.
Here are the links to the two measures:
This is the bill under the jurisdiction of the House Energy and Commerce Committee.
This is the language (mainly dealing with taxes) under the jurisdiction of the House Ways and Means Committee.
Much easier to read is the section by section analysis: