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Donald Trump and Republicans in Congress are vowing to replace the Affordable Care Act with their own health care system. So what would that look like? Well, a plan from a leading Republican, House Speaker Paul Ryan, could offer some hints. NPR's Alison Kodjak reports that the Ryan plan is seen sort of as Obamacare lite.
ALISON KODJAK, BYLINE: Ryan introduced his plan last summer flanked by a handful of House members at a Washington think tank. The upshot...
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PAUL RYAN: Don't force people to buy insurance. Make insurance companies compete for our business. And, yes, we're going to help you buy insurance.
KODJAK: While the Ryan plan gets rid of the mandate to buy insurance, it otherwise has many provisions that will be familiar to people who know Obamacare. It offers tax credits to help people pay for insurance, and it protects people with medical conditions from losing their coverage. Jim Capretta is a health policy fellow at the conservative American Enterprise Institute.
JIM CAPRETTA: Republicans, through this have embraced, and I think rightfully so, the basic idea that everybody in the United States should have health insurance. And for people that are outside the employer system, they should get some level of financial help through a tax credit.
KODJAK: The main difference from the Affordable Care Act - Ryan tries to move people into high-deductible health plans along with health savings accounts, so they'll save up to pay for their own basic care. That could keep premiums down for young, healthy people, says Paul Howard, director of health policy at the conservative Manhattan Institute.
PAUL HOWARD: Most of the care that most of the people are going to need for most of their adult lives can be very inexpensive.
KODJAK: So rather than paying a lot for insurance they don't need, people could save that money for when they get sick.
HOWARD: By the time you're 40, I think, ideally, you would have built up, you know, through a health savings plan that would be, you know, partially funded by government sources plus your own sources, a significant nest egg.
KODJAK: Ryan also wants to limit tax breaks for employer-based insurance to nudge companies into buying cheaper, high-deductible plans, too. Howard says workers may prefer that if they know how much of their compensation went to health insurance.
HOWARD: Do you know that $20,000 of your wages are going every year to insurance? Would you rather have, you know, $10,000 in your pocket, a $5,000 high-deductible plan or something like that, and then put some aside for a rainy day that'll accumulate over time?
KODJAK: Conservatives argue that making people buy their own health care, even with money provided by the government, will get them to shop around and lower costs in the long run. Ryan wants to launch his new system with a single open enrollment period, not the annual sign-up windows offered under Obamacare.
People with ongoing medical conditions who maintain their coverage can't be cut off. And if their insurance lapses, they'll be offered a government-run health plan called a high-risk pool. But high-risk pools have been tried before in 35 states and failed, says Sabrina Corlette, a professor at Georgetown's Center on Health Insurance Reforms.
SABRINA CORLETTE: When you put people with high health care needs into what I call a health insurance ghetto, which is these high-risk pools, the costs are going to be exorbitantly high.
KODJAK: Corlette says Ryan's plan covers fewer people and offers fewer benefits.
CORLETTE: What Paul Ryan has called for is a much skimpier set of protections so that that tax credit buys you a lot less than what it would have under the ACA.
KODJAK: Now that Ryan's been re-elected as speaker, his proposal is likely to be the opening bid in the upcoming effort to overturn Obamacare. Alison Kodjak, NPR News, Washington.
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