GOP’s ‘Pledge To America’ Replaces Affordable Care Act With Provisions From Affordable Care Act

Starting today, insurance companies can no longer discriminate against children with pre-existing conditions, drop coverage because of a simple mistake on an application, institute lifetime caps, limit choice of doctors, charge more for emergency services obtained out of network, or levy deductibles, co-payments or co-insurance for certain preventive benefits. Children will also be able to stay on their parents’ plans until their 26th birthday and everyone will have the right to appeal insurer decisions to an independent third party.

Ironically, today Republicans are also unveiling a new ‘Pledge To America,’ an agenda which promises to “repeal” all of these benefits — as well as the entire health care law — and replace it with “reforms  that  lower  costs  for   families  and  small  businesses,  increase  access  to  affordable,  high-­‐quality  care  and  strengthen  the  doctor-­‐patient   relationship.” The document provides almost no specifics about what the party would do to control health care spending, improve quality, or pay for its reforms. And at least 7 of the GOP’s ideas on health care are already included in the health care law:

Affordable Care Act GOP’s ‘Pledge To America’

Insurance Across State Lines Allows for the creation of State Health Insurance Compacts – permits states to enter into agreements to allow for the sale of insurance across state lines. (SEC. 1333; p. 100-101) “We  will  allow  individuals  to  buy  health  care   coverage  outside  of  the  state  in  which  they  live. ” (p. 15)
High-Risk Insurance Pools The states and the federal government have already established high-risk insurance pools to provide temporary coverage to individuals with pre-existing conditions until 2014. (SEC. 1101; p. 30-33) “We  will  expand  state  high-­‐risk  pools,   reinsurance  programs  and  reduce  the  cost  of  coverage” (p. 15)
Pre-Existing Conditions Children cannot be denied coverage starting today, but beginning in 204, insurers must accept everyone who applies. (SEC. 2702-2705; p. 46-51) “We  will  make  it  illegal  for  an  insurance   company  to  deny  coverage  to  someone  with  prior  coverage  on  the  basis  of  a  pre-­‐existing  condition.” (p. 15)
Lifetime and Annual Caps A health insurer cannot impose lifetime limits and will be prohibited from placing annual limits on plans beginning in 2014. (SEC. 2711; p. 14) “[E]liminate  annual  and  lifetime  spending  caps” (p.15)
Recissions A health insurance issuer cannot rescind a policy except for in cases of fraud. (SEC. 2712; p. 14) “[P]revent  insurers  from  dropping  your  coverage  just   because  you  get  sick.” (p.15)
State Innovation States can receive waives from certain requirements if they can cover the uninsured and lower health costs in a more innovative manner. (SEC. 1332; p. 98-100) “We  will  incentivize  states  to  develop  innovative  programs  that  lower   premiums  and  reduce  the  number  of  uninsured  Americans.” (p.15)
Conscience  Protections The law does not affect existing conscience protections or discriminate “on the basis of the willingness or refusal to provide, pay for, cover, or refer for abortion or to provide or participate in training to provide abortion.” (SEC. 1303; p. 67) “We  will  also  enact   into  law  conscience  protections  for  health  care  providers,  including  doctors,  nurses,  and  hospitals.” (p.15)

The document doesn’t detail how Republicans plan to offset the $140 billion deficit increase that will result from repealing the ACA or how they’ll lower health care spending. The Congressional Budget Office estimated that the GOP’s previous very similar health care plan — presented by House Minority Leader John Boehner (R-OH) as an alternative to the House health care bill — would increase the number of uninsured to 52 million in 2019 and reduce the deficit by only $68 billion over the 2010–2019 period.

Moreover, as conservative health care blogger Avik Roy points out, “the Pledge says almost nothing about the biggest and most difficult questions in health policy: Medicare and Medicaid reform.” “It criticizes PPACA’s ‘massive Medicare cuts’ without offering an alternative solution for putting the program on stable long-term footing.” CMS estimated earlier this month that under the health law, Medicare spending will decline $86.4 billion from previous projections due to reforms. “Specifically, average annual Medicare spending growth is anticipated to be 1.4 percentage points slower for 2012–19 than we projected in February 2010. By 2019, it is projected to grow 7.7 percent—0.9 percentage point more slowly than we projected in February 2010,” the report concluded. Repealing the law would increase in Medicare spending. How do the Republicans plan to hold down those costs? On that their document is absolutely silent.