On September 23, 2010, Congressional Republicans released a document entitled “A Pledge to America” to help voters in November better understand their position on a broad set of policy issues. Featured in the document, is a pledge to repeal the Patient Protection and Affordable Care Act (ACA), and replace it with “common-sense solutions focused on lowering costs and protecting American jobs.”

Summary of GOP Repeal and Replace

Repeals all provisions of the ACA and would replace with: medical liability reform; prohibiting coverage denials and annual and lifetime spending caps for people with prior coverage who have or develop pre-existing conditions; allowing the purchase health insurance across state lines; expanding health savings accounts, strengthening the doctor-patient relationship, ensuring access for patients with pre-existing conditions, expanding high risk pools and reinsurance and provides incentives to states to develop programs to lower premiums and increase coverage, and permanently prohibiting taxpayer funding of abortions.

Key Differences between ACA and “Pledge” Principles

Insurance Reforms

The ACA prohibits health insurance discrimination against all individuals with pre-existing conditions and limits the ability of insurers to charge higher premiums for the sickest individuals. The GOP replacement prohibits insurance discrimination against people who had previous coverage, but does not apply to individuals who are uninsured or have breaks in coverage, and places no limits on how much more an insurer may charge for the sickest individuals. The ACA provides for temporary high-risk pools and reinsurance coverage until insurance reforms are effective, and the GOP replacement does not appear to end those programs. The ACA provides grants to states to establish insurance exchanges, a marketplace for those without employer coverage and small businesses. The GOP replacement allows the purchase of insurance across state lines and lets small groups join together to purchase coverage.

Affordability

The ACA provides tax credits to families and small businesses to help them afford premiums, and expands the Medicaid program for the poorest individuals. The GOP proposal would expand health savings accounts (HSAs) that accompany high-deductible health plans, and provide incentives to states to lower premiums and reduce the number of uninsured Americans.

Improving Quality and Lowering Health Costs

The ACA includes provisions to improve quality and lower costs through delivery system reforms such as chronic disease management, medical homes, anti-fraud initiatives and investments to improve workforce, public health and long-term care. The GOP replacement would lower costs through medical liability reform.

Impact on the Federal Deficit

The ACA reduces the deficit by $143 billion from 2010-2019. The document does not indicate whether the GOP plans to pay for the cost of repeal, which if unaddressed, will add an estimated $455 billion to the deficit over the next 10 years, the document does, however, indicate that the GOP plans to “put the government on a path to a balanced budget.”

Taxpayer Coverage of Abortion Services

Since 1976, federal appropriations law has imposed limits on the use of federal funds to finance abortions. The ACA establishes restrictions on abortion coverage in the case of individual and group health plans sold in state exchanges. The GOP replacement “permanently prohibits taxpayer finding of abortion.” For more information on ACA and abortion coverage see the implementation brief: Abortion Coverage.

Impact on Current Law

Although many provisions of the ACA do not go into effect until 2014, some provisions have already been implemented. Those provisions already in place which would be repealed include among other provisions: phase-one of closing the Medicare prescription drug “donut hole,” permitting dependents to age 26 to remain on their parents insurance policies, tax-credits to small businesses to help them afford health insurance coverage for their employees, prohibiting insurers from imposing pre-existing conditions for children, home and community-based care options for seniors and individuals with disabilities and grants to community health centers. For a complete listing of provisions that have been implemented and would be repealed, see the Editor’s Comment: Six Months and Counting.