Okay, let's break down the new GOP health care replacement plan released this afternoon:
Things about the ACA that they like, and are going to keep:
1. The individual mandate (being changed from a penalty charged by the government to a penalty charged by insurance companies).
2. Kids can stay on insurance until age 26.
3. Insurance companies can't deny you if you have a pre-existing condition (though they can charge you more).
4. Some form of refundable tax credits (though they will be smaller and applied differently).
5. The Cadillac tax on super-plush plans is being retained (though it has never gone into effect, as Obama delayed it).
6. The ban on lifetime caps stays in place.
Things about the ACA that they hate, and are going to change:
1. The individual and employer mandates are technically gone. No one "needs" to be insured. freeeedooooooooomm! (and market collapse!)
2. Expanded medicaid is being removed, starting in 2020, kicking millions of people off of their current insurance.
3. The refundable tax credits are cut (roughly in half) and will now be given to old poorish people instead of all poor people.
4. Strips all funding from Planned Parenthood. Only poor people use planned parenthood anyway.
5. Removes the medicare surtax for people earning over $250k/year. Yay for tax breaks for the rich!
6. Forbids private health insurance from covering abortion.
All plan controls are removed. You will now pay extra if you want maternity, prescriptions, or mental health care to be covered. mostly retained.
Things NOT included in the plan, that we thought would be, but that aren't part of the ACA:
1. HSA expansions?
Apparently not included, will stay the same. Some sources are now reporting HSA limits would double.
2. Removing tax exemption for employer-sponsored care? Apparently not included, will stay the same.
As far as I can tell, this plan fails to deliver on everything Trump has promised. It doesn't make coverage more available or more affordable, in fact it does exactly the opposite. Tens of millions of people will lose their current insurance, and everyone else will either either pay more for their current coverage or pay the same for less coverage. It seems designed to make health care harder to find in rural areas. And it doesn't even begin to address any of the cost controls that might actually reduce the price of care, instead of the cost of insurance.
Basically, it makes very few structural changes to the ACA other than that poor people will get less subsidies and rich people will pay less taxes. The only other major change is to block-grant Medicaid and restrict abortion, which are both long-time Republican fantasies and things they could have done separately from any ACA plan anyway.
From that perspective, the whole "repeal and replace" plan is basically just tax cuts for the rich, slashing welfare, and banning abortion. There is nothing new under the sun, this is the same old GOP platform they've been pushing since the 80s.