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 But key parts of it may resemble the one President Barack Obama
delivered five years ago in the Affordable Care Act, partly
reflecting Republican concerns that they could pay a political price
if insurance subsidies are yanked from millions of Americans later
this year.
Two front-running Republican options at an early stage in Congress
include a refundable tax credit that experts say is virtually the
same thing as the Obamacare tax subsidy being challenged before the
Supreme Court. Republicans deny that their ideas are tantamount to "Obamacare
Lite" but acknowledge they will need bipartisan support for their
plans to stand any chance of avoiding an Obama veto.
"It's not going to be like Obamacare, in my opinion," said Senate
Finance Committee Chairman Orrin Hatch, whose plan includes a
refundable tax credit for low-and middle-income Americans.
“It’s not a literal subsidy, it’s a recognition that they should
have this credit."
Republicans have been vowing for years to repeal and replace
Obamacare, the president's signature policy achievement that
Democrats passed in 2010 over united Republican opposition.
Democrats say the act is insuring more Americans and helping to slow
the growth in healthcare spending.
Conservatives call Obamacare a government overreach that drives up
health costs. They object to its mandates -- that everyone have
insurance, that employers offer it, and that insurance plans must
cover certain items.
But Republicans have never united around a replacement strategy.
There is renewed interest in producing one now, however, to be ready
if the Court rules for the plaintiffs in the current Obamacare case
and disallows tax subsidies through the federal exchange in a ruling
expected in June.
Up to 7.5 million people in at least 34 states that use the federal
exchange could then lose their tax subsidies, according to the
consulting firm Avalere Health, dealing a possibly fatal blow to the
program.
Democrats and the White House have said little about what they might
do if the Supreme Court rules against the administration. No
replacement could go into effect before 2017 unless Obama signs it
into law.
BIPARTISAN PROSPECTS
Some experts see bipartisan potential in key elements of what
Republicans like Hatch, of Utah, and House Ways and Means Committee
Chairman Paul Ryan, of Wisconsin, have discussed to date.
The refundable tax credits in both their plans would be available to
those who pay little or no tax, similar to the Obamacare subsidies
for low-income Americans.
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"There is a lot of common ground here," said Stuart Butler, a senior
fellow in economic studies at the Brookings Institution, who called
the refundable credits "essentially indistinguishable" from the
Obamacare subsidies.
One difference is that Republicans would allow the tax credits to be
used to buy insurance in the private market, an approach they say
will help drive down insurance costs and give consumers more
options. Under Obamacare, the credits can be obtained only through
the state or federal online exchanges.
In an e-mailed statement to Reuters, Ryan said tax credits would
"empower Americans to make their own healthcare decisions rather
than government mandates.”
Ryan and Hatch have yet to introduce legislation, but their
approaches also diverge from Obamacare in other ways. For example,
both lawmakers favor allowing government mandates to be lifted, and
letting consumers buy insurance across state lines.
Tax subsidies are popular. A Reuters-Ipsos poll conducted March
6-April 13 said that 79 percent of adults favor providing subsidies
on a sliding scale to aid individuals and families who cannot afford
health insurance. But Obamacare itself remains divisive. In the
poll, 53 percent said they were opposed to it.
More Republican proposals are popping up. If the Court rules against
the administration, Wisconsin Senator Ron Johnson wants to make the
Obamacare taxpayer subsidies available through August 2017, while
repealing the individual and employer mandates.
Louisiana Republican Representative John Fleming favors putting
taxpayer money into tax-exempt health savings accounts that
individuals can use to pay for healthcare expenses.
"Doing nothing, or not covering more people, was never a goal of
Republicans,” Fleming said.
(Reporting by Susan Cornwell; editing by Stuart Grudgings)
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