Senator Rand Paul introduced the
Obamacare Replacement Act on January 25th, which would repeal much of Title 1 of the Affordable Care Act (ACA), including:
- Most consumer protections (except as outlined below)
- Rating restrictions
- Rate review requirements
- Essential Health Benefits
- Medical loss ratio requirements
- Individual and employer coverage mandates
The bill would restore certain market rules:
- Coverage under family plans for young adults up to age 26
- Requirements related to coverage of clinical trials
- Requirements related to disclosure of information about health plans
- Non-discrimination against providers
In place of the individual coverage mandate, the bill would provide a limited two-year open enrollment period for those with preexisting conditions and otherwise only provide HIPAA preexisting condition protections in the group market.
The bill would also eliminate the tax exclusion for employer-based premium payments and instead provide a universal payroll and income tax deduction. It would also expand Health Savings Accounts (HSAs), provide tax credits via HSAs, remove contribution restrictions and requirements that HSAs be used with High-Deductible Health Plans, expand allowable HSA expenses (including for use for premiums), and allow HSAs to be retroactive and rolled-over.
The bill would expand Association Health Plans and create Independent Health Pools to allow individuals and small groups to band together to purchase large group insurance that is not subject to individual and small group rules, including benefit mandates. It would also allow coverage licensed in one state to be sold in other states, subject only to consumer protections and taxes in subsequent states.
Physicians would be eligible for tax deductions for uncompensated care and providers would have greater antitrust protections when negotiating contracts with insurers.
States would also have greater flexibility under Medicaid waiver authority.
Lisa Kaplan Howe (J.D.) is a Senior Advisor who has spent her career working in health law and policy. At PCG, she focuses on statutory and regulatory analysis and strategic advising, particularly related to health care policy. Lisa has provided subject matter expertise to support state health care reform efforts, including policy development and regulatory support for health insurance Marketplaces and state insurance plan management efforts, Medicaid expansion and Medicaid Waivers (including DSRIP Waivers) and State Innovation Waivers. Lisa led PCG’s work with the New Hampshire Insurance Department relative the state’s Section 1115 Medicaid Waiver to provide coverage to newly-eligible adults through the Marketplace and continues to support the states’ Marketplace plan management work. In those roles, Lisa has served as the chief advisor and policy expert related to Medicaid and private insurance law to the New Hampshire Insurance Department, helping to identify, analyze and lead strategic consideration of federal opportunities and requirements. Lisa is also part of the team helping to design Colorado’s Delivery System Reform Incentive Payment (DSRIP) program. Ms. Kaplan Howe also provides broad policy and regulatory support to PCG’s other health care clients across the country, analyzing policy and regulatory developments, providing strategic advice relative to regulatory questions, and drafting policy briefs and position papers. Lisa is a managing editor of PCG’s monthly health practice area newsletter, Health Policy News.
Prior to joining PCG, Lisa served as Policy Director at New Hampshire Voices for Health, where she led legislative and regulatory analysis, strategic planning, and implementation of the organization’s policy agenda. Her work included drafting bills, amendments, testimony, and communications and testifying at hearings. Lisa also held the positions of Private Market Policy Manager and Consumer Health Policy Coordinator at Health Care for All of Massachusetts. While there, she managed private insurance market policy work and was a member of the organization’s internal health reform team. Lisa also practiced law in the Ropes & Gray health care department, advising health care provider and insurer clients.
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