Comparison of Key Repeal and Replace Proposals

As the incoming Congress and administration develop plans to “repeal and replace” the Affordable Care Act (ACA), analysis of five earlier repeal and replace proposals provides insights into the key features likely to appear in any forthcoming repeal and replace legislation. Manatt Health performed a side-by-side comparison across 19 core areas—including tax credits, Marketplaces, individual and employer mandates, dependent coverage, risk pooling, Medicaid expansion and financing, guaranteed issue and preexisting conditions, ratings, and benefits—of the following five existing proposals:

  • Speaker Paul Ryan and the House Republican Caucus’s 2016 proposal;
  • Legislation sponsored by House Budget Committee Chairman Tom Price, President-elect Trump’s nominee to lead Health and Human Services;
  • A proposal co-sponsored by Senators Orrin Hatch and Richard Burr and Representative Fred Upton;
  • A proposal from the Heritage Foundation; and
  • The reconciliation bill (H.R. 3762) passed and vetoed earlier this year, noting the areas that were and those that were not addressed in that reconciliation bill. (Many of the excluded provisions are assumed to be outside of the scope of reconciliation.)
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The five proposals analyzed range from a 242-page draft of legislation sponsored by Representative Price to an 8-page concept paper published by Senators Hatch and Burr and Representative Upton. Across these different formats there was significant variation in the level of detail, with some proposals providing answers to key policy questions and others merely outlining an approach.