“Ryan said the GOP plans to push refundable tax credits that would allow low-income Americans to essentially use those tax credits as vouchers to buy insurance, rather than receiving government-funded Medicaid.”
So the new GOP plan is to keep the preexisting conditions ban, keep age 26, repeal the individual mandate, and replace ACA subsidies with refundable tax credits.
Whether the subsidies come through the ACA or through the IRS seems insignificant, in both cases the federal deficit is paying private companies to provide people healthcare.
So thus far the only other proposed change to Obamacare under the new plan is to repeal the individual mandate. Great! I'm totally on board with this plan. The individual mandate was just a gift to the insurance companies, it does nothing to help Americans (except help their insurance providers turn a profit). Of course, the insurance lobby is going to bring billions of dollars of pressure to keep the individual mandate because it's how they make money, but I'm also okay with the government telling the insurance industry to fuck off. Your profit margins are obscene, maybe consider helping more people and funding fewer top-level CEO golden parachutes.
Without an individual mandate, insurance companies will just raise rates on people who have insurance to pay for the ban on excluding people with pre-existing conditions. That's just basic capitalist economics. If the government were to effectively nationalize the insurance industry by capping rates, they will either be less profitable (my preference) or go bankrupt (nobody's preference). If they don't cap rates, and rates go through the roof, and they offer people refundable tax credits (ACA subsidies in disguise), then that just continues the problem of Uncle Sam escalating every higher insurance rates for everyone. That's the exact opposite of the cost controls that the ACA was designed to impose (and that Republicans claim to want).
So far, this whole thing is a clusterfuck of the highest order. We're only getting bits and pieces of the discussion that must be going on behind closed doors, but I fee like Republicans are having an oh-shit moment when suddenly faced with the prospect of actually fixing American healthcare in some way that is demonstrably different from the ACA plan they previously tried (proposed by the Heritage Foundation, piloted by Romney in MA), which they now have to oppose because Democrats endorsed it. They're on record as violently opposed to their own plan A, so what's their plan B?
I admit there's a certain sense of schadenfreude in it for me, as a liberal. You didn't like your own idea when we tried to pass it for you? Fine, you now have 100% control of all branches of government, it's your turn to try something else and there is absolutely no excuse for not getting exactly everything that you want. If only you could figure out what that is. Once you decide, you will own it. Good luck!