President Donald Trump discusses the federal budget in the Roosevelt Room of the White House on February 22, 2017 in Washington, DC.

A draft bill detailing Republican plans to begin repealing and replacing many facets of the Affordable Care Act would provide expanded tax credits and health savings accounts for individuals while reducing federal spending on tax subsidies and Medicaid and practically eliminating both the current employer and individual mandate to provide and carry health insurance.

The 105-page draft legislation, obtained by NBC News, repeals much of the current law, also known as Obamacare, within the next few years and sets in place a Republican vision of healthcare.

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The draft, dated February 10, is circulating among health care lobbyists and, while changes are possible, it is believed to be a legitimate effort at health care reform. The legislation, which also cuts funding to Planned Parenthood, still has to be scored by the non-partisan Congressional Budget Office, for a full accounting of how much it would cost, but the largest funding mechanism is a tax on the most expensive employer-provided health insurance plans.

What isn't included is a guarantee that people with pre-existing conditions are able to obtain coverage. Members of the House, however, introduced a bill last week to preserve the pre-existing condition ban, signaling that it would have to be passed separately.

The bill dismantles some major components of the ACA, including the expansion of Medicaid and the subsidies to purchase health insurance.

In its place, Americans who need assistance to purchase health care will receive a tax credit - able to be received in advanced on a monthly basis - based on age. A person under 30 is eligible for a $2000 tax credit while a person over 60 is eligible for a $4000 credit.

As for Medicaid, Republicans propose placing a cap on the number of Medicaid recipients in each state based on population, which would likely largely reduce the 72 million Americans currently receiving Medicaid. The current Medicaid expansion allows coverage for people based on income. The transition begins in 2020.

They have also carved out exceptions for some medicaid recipients with pre-existing conditions to ensure they keep their medicaid coverage, including cervical and breast cancer or are blind, which are specifically noted.

The measure also also creates state-based high risk pools for people who don't have access to insurance. The federal government would start in 2018 providing $15 billion to help fund the high risk pools, but the number decreases to $10 billion by 2020 and beyond.

And the legislation would greatly expands the use of Health Savings Accounts, a tax deductible way to purchase health insurance, which has become a top Republican priority.

The measure does not directly get rid of the individual and employer mandate to purchase and provide health care, but it zeroes out the penalty, making violation of the mandate non-enforceable.

Republicans, struggling to figure out a way to pay for their health insurance plan, puts in place a tax on the most expensive employer-based health insurance plans, which is an expanded version of the so-called Cadillac tax.

The measure repeals unpopular taxes opposed by the business community and health field, including the medical device tax and the tax on health insurance, also known as the HIT tax, that helped to pay for the ACA.

The plan is already being panned by some.

Ron Pollack, head of the Families USA, which advocates for health consumers, said the draft "buys less care — or no coverage at all."

"This leaked Republican proposal, if enacted, would put us on a destructive path that would decimate the safety-net Medicaid program for over 72 million people; drastically reduce premium subsidies for working families; and cause out-of-pocket health costs to soar," Pollack said.</s>“They’ll fix Obamacare, and I shouldn’t have called it repeal and replace because that’s not what’s going to happen. They’re basically going to fix the flaws and put a more conservative box around it,” insisted former Republican House Speaker John Boehner of Ohio at a healthcare conference in Orlando.

Boehner’s comments received immediate push-back from some Republicans who are just as insistent that the troubled government health care program is going to be junked. “The last time I checked, Boehner doesn’t have a vote anymore,” reacted Senator Ted Cruz (R-Texas). “This is a test. It’s a test for Republicans in the executive and both houses of Congress. Do we honor the promises we made? This election was a referendum on repealing Obamacare. I think failure is not an option.”

Cruz concluded, “We’ve got to keep that promise, and I believe we will.”

The question is, Will the Republicans pass the “test” of keeping their much-repeated promise to repeal ObamaCare?

Boehner contends that Republicans are simply too divided on exactly what to do after the repeal of the hated law to fulfill their pledge to ditch the law. In fact, Boehner ridiculed the very idea that Republicans would do so, saying that he “started laughing” when Republicans claimed that they are going to move at lightning speed to repeal ObamaCare — and then pass an alternative.

“In the 25 years that I served in the United States Congress, Republicans never, ever, one time agreed on what a health care proposal should look like. Not once.”

The dilemma facing the Republicans is instructive. Once a new government program is in place, it becomes extremely difficult politically to ever abolish it, no matter how bad it is. Former President Ronald Reagan lamented that a government program was the closest thing to eternal life found on this planet. While a majority of Republicans can agree that they do not want ObamaCare, they must cobble together enough votes for what to do instead of it — replace it with a new program, repair the program, or simply let it die.

“I told some of the Republican leaders when asked, I said, if you pass repeal without replace you’ll never pass replace, because they will never ever agree on what the bill should be. Perfect always becomes the enemy of the good,” Boehner argued.

Another concern among Republicans is that the Democrats will filibuster a repeal of the law. And, while Republicans could axe much of it through the budget reconciliation process, they cannot use that for all parts of the bill.

But other Republicans are not buying that objection. Speaking at the Conservative Political Action Conference this past week, Representative Mike Burgess (R-Texas), told attendees, “Yeah, it’s gonna happen. We will get it done.” The only time frame he could offer, however, was that ObamaCare would be gone before next year’s CPAC meeting in February 2018.

Burgess is the chairman of the Health Subcommittee of the House Energy and Commerce Committee, which is working on a replacement to the healthcare law. He said that those parts of the bill which cannot be nixed by the reconciliation process can be gutted via administrative changes. The repeal bill would be just the “opening act to take Obamacare out.”

The most important thing to eliminate, Burgess said, was the individual mandate.

“We must and we can repeal Obamacare now,” said former Senator Jim DeMint (R-South Carolina), who now leads the Heritage Foundation. He asked CPAC attendees to pressure their own senators and House members to just pass the same clean repeal bill to President Trump which was vetoed by former President Obama. “They should send that same bill to President Trump right now.”

DeMint rejected the argument that Republicans must have a replacement package in place before repeal, calling it “absolutely ridiculous.”

He contended that doctors, hospitals and insurance companies would not vanish just because ObamaCare was repealed. This is, however, the message put out by much of the liberal media, and the Congressional Budget Office (CBO) has stated that as many as 18 million would lose their health insurance, followed by higher premiums, if the law was repealed.

Ironically, it was the Heritage Foundation that first floated the idea of the individual mandate as a way to make sure the system was not overloaded with freeloaders who could afford health insurance, but just decided not to take it. The concern then was that millions of Americans who neglected to be insured then wound up on some public method of coverage when some had an unexpected accident or catastrophic illness.

DeMint was not the president of Heritage at that time, and the more limited mandate concept that Heritage suggested in the 1980s was dropped years ago.

The House Freedom Caucus has voted to simply pass the same repeal bill that Obama vetoed. Former Caucus Chairman Jim Jordan (R-Ohio) said, “I start from the premise that health care will be better and cost less when Obamacare is gone.”

Among the more popular replacement plans has been offered by Representative Mark Sanford (R-South Carolina), and Senator Rand Paul (R-Kentucky). Paul favors a simultaneous repeal and replacement of ObamaCare. Jordan said he would favor a free-market replacement at the same time, if it were up to him, “But if it doesn’t [happen] of course I’m going to vote to repeal it.”

The Paul-Sanford Plan would terminate the Medicaid expansion of ObamaCare, detach health insurance from employers, offer a tax credit (up to $5,000) to fund Health Savings Accounts (HSA’s), eliminate the bulk of the costly regulations of ObamaCare dictating what health plans must cover, and allow insurers to sell policies across state lines. The present ObamaCare regulation, which forces even single men to purchase maternity coverage, would be ended, along with the present mandates for birth control coverage.

“We were tired of waiting” on House leadership to roll out a plan, Jordan said, explaining why the House Freedom Caucus has gotten behind the Paul-Sanford plan. “That’s why we said: Let’s go. Let’s go now.”

Senator Paul argued that HAS’s would drive down the cost of healthcare. “What if 30 percent of the public had Health Savings Accounts? What do you do when you use your own money? You call up doctors and ask the price... if you create a real marketplace, you drive prices down.”

The money in the plan for HAS’s could not be used fund elective abortions.

The tax credit idea in the Paul-Sanford legislation is at odds with a plan floated by Speaker of the House Paul Ryan, who wants a “refundable tax credit” to help consumers pay for various plans. To some critics, however, this is considered too similar to the subsidies offered to purchase insurance on the “exchanges” created by the Affordable Care Act.

Paul was among those critics of the Ryan proposal. He said he favored a smaller tax credit, one that “not everybody” would receive. “It’s not refundable in the sense that if you didn’t pay taxes you get money. A new refundable tax credit is a subsidy by another name.”

Some Republicans are no doubt wary of 2018 congressional elections, in which 24 Republicans must seek re-election in districts won by Hillary Clinton in the last presidential election. While there is a presumption that the supporters of ObamaCare are mostly lower-income individuals, the reality is that powerful corporate interests, such as hospital chains, favor anything they believe puts more money into their bank accounts. And these are the folks that write campaign checks.

In the end, in order to get a bill through Congress Republicans will likely have to build that will please those who favor outright repeal of ObamaCare, and those who simply want to “repair” it.

Because of the conflicting viewpoints, which divide congressional Republicans, many members of Congress are looking down Pennsylvania Avenue, hoping the White House will take leadership of the issue.

Perhaps the most powerful lesson in all of this is the best way to get rid of a government program is to not enact it in the first place.</s>Top Republicans are now publicly saying that Obamacare will never be fully repealed. In fact, many Republicans in Congress are already using the term "repair" instead of "repeal" to describe what is going to happen to Barack Obama's signature health care law.

Without a doubt, the Republicans in Congress are eventually going to do something, but strategists in both parties are now suggesting that most of the key elements of Obamacare are going to remain once everything is all said and done. It will be put into a more "conservative" package, but it will still be Obamacare.

On Thursday, former House Speaker John Boehner made headlines all over the country when he said that a complete repeal of Obamacare is "not what's going to happen". Instead, Boehner said that Republicans are going to "fix Obamacare" and that they will "put a more conservative box around it" in order to keep their constituents happy.

Of course, this isn't what we voted for. For years, Republican politicians all across the country have been promising that Obamacare would be repealed once they got control of Congress, but now Boehner is telling us that all of that was just "happy talk":

Earlier in the panel discussion, Boehner said he "started laughing" when Republicans started talking about moving lightning fast on repeal and then coming up with an alternative. "In the 25 years that I served in the United States Congress, Republicans never, ever, one time agreed on what a health care proposal should look like. Not once," Boehner said. "And all this happy talk that went on in November and December and January about repeal, repeal, repeal—yeah, we'll do replace, replace—I started laughing, because if you pass repeal without replace, first, anything that happens is your fault. You broke it."

When the Republicans finally get around to doing something, they will inevitably declare it to be a great victory, but will it actually be that much different from what we have now?

Yes, the IRS penalty for not having health insurance will probably go. But there will still be coverage for children up to the age of 26, there will still be mandatory coverage for pre-existing conditions, there will still be mandatory coverage for maternity expenses, there will still be some form of Medicaid expansion, and there will still be subsidies for the poor.

In the end, we are still going to have a health care system where half the country pays for the health care for the other half of the country.

That isn't fair, and it never will be. One half of the country shouldn't have to pay much higher rates for their own health insurance and pay for the health care of everyone else in the nation as well. Either we should go back to a free market system, or they might as well go ahead and socialize the entire thing.

The thought of sticking with what we have right now is utter insanity, but unfortunately, that is what top Republicans mean when they speak of "repairing" Obamacare. The following comes from The New York Times:

How in the world do you "repair" a steaming pile of garbage?

What the Republicans need to do is very simple. As Jim DeMint has suggested, the Republicans in Congress simply need to pass the same Obamacare repeal that Barack Obama vetoed not too long ago:

So what is keeping Republicans in Congress from moving forward?

One thing is the defunding of Planned Parenthood. Some liberal Republicans are promising to vote against any Obamacare repeal bill that defunds Planned Parenthood:

Another thing that is giving some Republicans pause are the angry protesters they are running into at town hall meetings:

Of course, a lot of those "angry protesters" are from Barack Obama's private army of more than 30,000 volunteers that are being deployed around the nation in a desperate attempt to defend Obamacare.

In the end, the truth is that the Republicans should be listening to the voters that sent them to Washington in the first place. Most of those voters expected an immediate Obamacare repeal, and now that it has not happened, it is making for a very confusing tax season. The following comes from Politico:

Until it is repealed, Obamacare will continue to kill jobs and will continue to kill the middle class.

It was one of the worst pieces of legislation ever written, and it boggles the mind that so many Republicans in Congress are hesitant about repealing it.

Unfortunately, just as I portray in my novel, America is rapidly going crazy.

We have been given over to a reprobate mind, and our leaders can't even seem to think straight any longer.

If Obamacare is going to be repealed, now is the time. Please contact your representatives in Congress and tell them that a "fix" will not work and that we want Obamacare to be completely repealed and replaced with a free market alternative.

Michael Snyder is the founder and publisher of End Of The American Dream. Michael's controversial new book about Bible prophecy entitled "The Rapture Verdict" is available in paperback and for the Kindle on Amazon.com.

Leaders are readers! Subscribe now and get 3 magazines for the price of 1. Get Ministry Today, Charisma and SpiritLed Woman all for $24. YES - Sign me up!

3 Reasons Why you should read Life in the Spirit. 1) Get to know the Holy Spirit. 2) Learn to enter God's presence 3) Hear God's voice clearly! Click Here to draw closer to God!</s>Cathey Park of Cambridge, Massachusetts wears a cast for her broken wrist with "I Love Obamacare" written upon it prior to U.S. President Barack Obama's arrival to speak about health insurance at Faneuil Hall in Boston October 30, 2013. REUTERS/Kevin Lamarque

Details of potential Obamacare replacements by U.S. House Republicans emerged in news reports on Friday, as Republican lawmakers have vowed to introduce new legislation in the coming weeks.

Republicans have yet to agree on a single detailed policy proposal to repeal and replace the Affordable Care Act, the signature domestic policy of former Democratic President Barack Obama.

Still to be worked out are details including the future of Medicaid, the government health insurance program for the poor that was expanded in more than 30 states under Obamacare, and how a new healthcare law would be funded.

One emerging scenario among Republicans is that the millions of people who received health coverage through the expansion of Medicaid would be “grandfathered in,” according to the Washington Post. States that did not expand Medicaid could receive more money through increased federal “disproportionate share” payments used to help hospitals that serve a large number of uninsured patients.

And a draft Republican replacement plan for Obamacare, which news outlet Politico uploaded to its website, would cap the amount of money given to states for Medicaid and end tax subsidies based on income for the purchase of individual plans in 2020.

House staffers would not comment on the authenticity of the document, which was dated Feb. 10. President Donald Trump and Republicans have said they would present a plan for repealing and replacing Obamacare in the coming weeks.

It is not clear whether there is sufficiently broad support among Republican lawmakers for all of the measures in the draft proposal, or how the plans might change as they move through congressional committees.

The draft “addresses the major issues and is a serious proposal for transitioning out of Obamacare,” said Ed Haislmaier, a senior research fellow and healthcare policy expert at the Heritage Foundation who was on Trump’s transition team.

“Clearly the details will continue to evolve and we’ll be watching as they do,” he said in an emailed statement to Reuters.

U.S. health insurance executives, many of whom have lost hundreds of millions of dollars on the Obamacare individual insurance markets, are due to meet with Trump on Monday, according to a Bloomberg report. A Blue Cross Blue Shield Association spokeswoman confirmed it was invited to the meeting and will attend.

Republicans have repeatedly pledged not to “pull the rug out” from millions of Americans who gained access to healthcare under the law, and recent polls show more respondents favoring Obamacare than opposing it.

The Kaiser Family Foundation found broad bipartisan support for maintaining federal funding for the Medicaid expansion, with 84 percent of respondents saying it was important to do so, according to a survey released on Friday. The poll also found the law has record levels of support, with more Americans now viewing it favorably than unfavorably.

“Obamacare has failed. We welcome any and all efforts to repeal and replace it that put patients first,” said Caitlin Oakley, a spokeswoman for the U.S. Department of Health and Human Services.

Democrats decried the draft proposal on Friday and said it would cause millions of Americans to lose their health insurance.

“The deeply harmful path House Republicans have laid out would spell disaster for families nationwide,” U.S. Senator Patty Murray, a Washington state Democrat, said in a statement. “President Trump, who promised families he would provide insurance for everyone, should be the first to oppose it.”</s>A draft House Republican repeal bill would dismantle Obamacare subsidies and scrap its Medicaid expansion, Politico reports.

“The legislation would take down the foundation of Obamacare, including the unpopular individual mandate, subsidies based on people’s income, and all of the law’s taxes. It would significantly roll back Medicaid spending and give states money to create high-risk pools for some people with pre-existing conditions. Some elements would be effective right away; others not until 2020.”

“The replacement would be paid for by limiting tax breaks on generous health plans people get at work — an idea that is similar to the Obamacare ‘Cadillac tax’ that Republicans have fought to repeal.”</s>Congressional Republicans who spent seven years promising to repeal Obamacare now face a do-or-die stretch on Capitol Hill, hoping to build unity and take the first steps to repeal the health care law before they break for Easter.

After being heckled by liberal activists and constituents back home last week, Republican lawmakers return Monday to Washington facing a grim situation: Obamacare is more popular than ever, and unity within their own ranks is proving elusive.

Still, Republicans say they must deliver on their promise to voters to nix the 2010 Affordable Care Act, saying the law will collapse on its own without a repeal and consumers will be the ones who suffer.

Leaders have promised to introduce a bill by mid-March.

“We’re working hard on legislation to deliver relief from Obamacare’s skyrocketing costs and dwindling choices, restore state control, strengthen Americans’ access to care and reinvigorate the free market in health care,” said Rep. Kevin Brady, Texas Republican and chairman of the House Ways and Means Committee. “I’m confident the House will move forward with legislation to do just that in March.”

House Speaker Paul D. Ryan, Wisconsin Republican, said repeal legislation will be marked up once congressional budget scorekeepers vet the plan for its impact on things like spending, deficits and how many people would be covered.

Yet Republicans in the House Freedom Caucus — about 40 members who frequently clash with leadership — are worried about the overall cost of the effort and the use of refundable tax credits, saying it is an entitlement and they don’t want to usher in “Obamacare light.”

They are itching to scrap the health care law, however, and treat all states the same under Medicaid, particularly those that resisted the Obama administration’s monetary incentive.

Centrist Senate Republicans who represent expansion states will face pressure to safeguard the federal matching funds that enabled their states to cover tens of thousands of needy residents.

Robert Laszewski, a health care policy consultant in Alexandria, Virginia, said Republican leaders have “their work cut out for them” in fashioning a plan that suits every faction of their party and can attract eight Senate Democrats, whose votes will be needed to fully repeal and replace the law.

“If they can’t get the process of repeal and replace moving in the next few weeks, there is no reason to believe they will every be able to do it,” Mr. Laszewski said.

At the same time, he said, “Democratic arguments that Obamacare should be left alone because it is working will make them look foolish if they do not cooperate in a fix.”

A leaked draft of the House Republican plans, dated Feb. 10 and first reported by Politico, calls for replacing Obamacare’s health insurance exchanges and income-based subsidies with tax credits based on age starting in 2020, which would help those without insurance secure private coverage. A person 30 or younger would receive subsidies of about $2,000, while someone older than 60 would receive double that.

Republicans say it will allow people to pour more money into tax-advantaged savings accounts that can be used for medical expenses and phase out generous federal funding for states that opted to expand Medicaid, the insurance program for the poor.

Republicans then want to cap federal spending on Medicaid through per-capita limits or block grants, saying the program’s budget will balloon out of control without a change.

Gone is the unpopular “individual mandate” requiring people to hold insurance or pay a tax, which proved to be ineffective at driving young and healthy people into Obamacare’s exchanges in great enough numbers.

Instead, Republicans want to dole out “innovation grants” to states so they can decide whether to set up a high-risk pool or other programs to cover people with pre-existing conditions who have been priced out of the market. They would let insurers charge consumers more if they haven’t maintained continuous coverage — a way to prevent people from signing up only when they get sick and need to submit claims.

Republicans haven’t said how they will pay for their plans, though the draft proposes taxing a portion of more generous employer-sponsored health care plans. Economists say that’s a good idea, but it would rankle labor unions that fought Obamacare’s “Cadillac tax” on generous health care plans.

Democrats say the solution to Obamacare’s troubles is to inject more government support, including taxpayers’ money, to help the middle class buy coverage and offering a government-run plan, or “public option,” to compete with private plans.

Liberals also say public opinion is on their side, citing the furious backlash to Republicans at town hall meetings across the country.

A poll by the Kaiser Family Foundation said 48 percent of Americans have a favorable view of Obamacare, while 42 percent do not. It is the best outlook for the health care law since Kaiser started keeping track in 2010, and it is largely driven by an uptick among independents.

“It’s no wonder Republicans are getting an earful back home from constituents who want them to turn back from their dangerous plan to make America sick again,” said Senate Minority Leader Charles E. Schumer, New York Democrat.</s>That's a rhetorical question, of course. Republicans see that they have two choices: They can snatch health insurance away from millions of people, or they can replace Obamacare with something that looks suspiciously like Obamacare-with-a-different-name. Wary of both alternatives, erstwhile anti-ACA zealots have spent the first month of the Trump administration doing little more than clearing their throats.

The framework laid out by House Speaker Paul Ryan and other GOP officials last week is part capitulation, part evasion. In no way is it worthy of being called policy.

The surrender comes in the promise to keep the most popular features of Obamacare, which are a guarantee of coverage for those with pre-existing medical conditions and a provision ensuring that dependents can remain on their parents' insurance until age 26. Republicans accurately calculate that taking either of these benefits away would be politically suicidal — and that Trump, who has promised health care for "everyone," probably would balk.

The evasion — let's go ahead and call it dishonesty — is that the GOP framework promises not to "pull the rug out from anyone who received care" under the ACA's expansion of eligibility for Medicaid, the federal health insurance program for the poor. But Republicans also plan to change Medicaid into a program of block grants to the states, with sharp reductions in federal funding.

In effect, House Republicans threaten to force states to do the dirty deed and strike millions from the Medicaid rolls. Governors from both parties are not amused.

The fundamental lie of omission in the GOP's repeal-and-replace framework is the absence of any sense of what the new system would cost — or how it would be paid for. A plan without a budget is little more than a daydream.

Republicans do make clear that they want to eliminate Obamacare's direct subsidies designed to help the working poor afford insurance. Instead, they prefer a system of tax credits, based not on income but on age. A 50-year-old billionaire would receive the same amount of tax relief as his or her 50-year-old gardener. Anything that makes our tax system even slightly less progressive warms the hearts of today's GOP leaders.

But whether the federal government pays out more in subsidies or takes in less revenue because of tax credits, the reality is the same: Guaranteeing access to affordable health care is expensive. Republicans can decide it's too costly and throw people off the insurance rolls, but if they do they will pay a grievous political price.

Make no mistake, this has been a bad patch for the ACA. The chief executive of one health insurance giant, Aetna, opined last week that Obamacare has finally entered the "death spiral" that Republicans have so gleefully predicted. And officials of another mega-provider, Humana, announced that the firm will not participate in the Affordable Care Act exchanges in 2018.

That is called self-fulfilling prophecy: Republicans predicted from the start that Obamacare would fail — and then did everything they could think of to sabotage the program.

But in one crucial sense, the Affordable Care Act succeeded beyond anyone's wildest dreams: It fundamentally changed the nature of the health care debate in this country. Access to affordable health care is now seen as a right not just for the elderly and the desperately poor but for all Americans; and government is seen as the guarantor of that right.

The fact that Republicans pledge to continue protections for those with pre-existing conditions, dependents up to age 26 and the 12 million individuals covered by Medicaid expansion illustrates how things have changed. The GOP once fought these provisions tooth and nail, calling them socialism disguised as compassion. Now the party embraces core elements of Obamacare as the new normal.

House Republicans have been hearing from constituents who would be bereft without the insurance they obtained under the ACA. A couple of GOP senators have even begun talking about repairing the law rather than replacing it. And whatever Congress eventually comes up with will have to pass muster with Trump, who promised to expand health coverage, not reduce it.

Republicans will win the battle over the "Obamacare" label. But Barack Obama already won the war.

Eugene Robinson is a columnist for the Washington Post Writers Group. He can be reached at eugenerobinson@washpost.com.</s>In recent days, several Republican lawmakers have faced crowds of constituents at town hall meetings around the country who are angry that they may be in danger of losing their health coverage.

A GOP draft bill, recently obtained by Politico, would likely do little to assuage these concerns.

The Feb. 10 document follows the broad policy outline released by Republicans last week just before they went home for a Congressional recess. It proposes cuts to federal payments to states that have expanded Medicaid and offers tax credits for people to buy health insurance.

"This would mean fewer people could afford health insurance and that the health insurance would likely cover less," says Larry Levitt, senior vice president at the Kaiser Family Foundation.

Under the plan, states that expanded eligibility for Medicaid would see their supplemental federal funding rolled back. The program would also be converted from a federal-state program that pays for all the health care beneficiaries get, to one where Washington sends a fixed amount of money to each state for each Medicaid enrollee.

To help people who don't get insurance through their employer buy coverage, the bill offers age-based tax credits that start at $2,000 for individuals under age 30. It would rise to $4,000 for those over 60. Those credits are unlikely to cover the full cost of a plan that pays for routine health care, but could potentially pay for insurance that protects against a catastrophic health event.

Levitt says those credits are less generous than the subsidies offered under Obamacare.

The draft bill is consistent with what Republicans have been saying they want to see in place of Obamacare, says Rodney Whitlock, vice president of health policy at ML Strategies.</s>Ever since Republicans saw Obamacare take place, they have attempted to remove it and replace it with something new, and now President Donald Trump has repealed it, so what is the Trump administration expected to replace it with? Details have been scarce since Trump repealed the Affordable Care Act earlier this month, but after he pushed the executive order out to do so, Americans were assured a replacement was coming.

Now it appears that new details have emerged regarding what Republicans are expected to replace Obamacare with. While Republicans have yet to agree on a detailed policy to replace Obamacare with, there is an interesting update regarding Medicaid. It of course expanded in more than 30 states under the Obama administration. Republicans have also been talking about how the new healthcare law would be funded.

The reason that Obamacare is disliked by many Americans has to do with its monthly tax for those uninsured and the high premiums. Americans certainly would want to remove both problems under the new healthcare law. According to the Washington Post, one popular idea among Republicans is that millions who get healthcare coverage through the expansion of Medicaid would be “grandfathered in.”

In addition to this, the states that did not expand Medicaid could get more money through an increased federal disproportionate share payments. This would be used to help hospitals that see a large number of uninsured people. Politico reports that there would be a cap on the amount of money given to states for Medicaid. The plan is to also end tax subsidies that are based on income for the purchase of the individual plans in 2020.

Ed Haislmaier, a senior research fellow and healthcare policy expert for the Heritage Foundation, claimed that the new plan “addresses the major issues and is a serious proposal for transitioning out of Obamacare. Clearly the details will continue to evolve and we’ll be watching as they do.”

Health insurance executives within the United States are expected to meet with Donald Trump on Monday according to a report out of Bloomberg. Blue Cross Blue Shield confirmed they would be at the meeting through their spokeswoman, meaning one of the top insurance companies in the country will be there to meet with the president. Many of these companies lost millions under Obamacare, so the new plan is expected to help them as much as it is to help Americans.

Some experts assume that if insurance companies are helped out, they may charge less for their coverage. This would, in turn, help every American who needs coverage that does not get it through their place of work. On top of this, employers who had to stop offering insurance may now have the ability to add insurance back with the possible lower cost.

Obamacare has helped millions nationwide, which made many Americans worry they may lose their healthcare coverage due to the removal of their help from Obamacare. Republicans know of this issue, which is why they have repeatedly pledged they would not take healthcare away from those who currently get help with their individual coverage through the health market that Obamacare helped establish.

Democrats claim the opposite is true, which has been their message since Democratic candidates went out for office. It will be interesting to see which is true, but according to Bloomberg‘s Zach Tracer, older people may be the ones at the most risk to lose their coverage or pay more for it without Obamacare’s help. United States Senator Patty Murray, a Democrat out of Washington, said in a statement,

The plan by the Republicans has yet to actually be finished as of now, with no concrete proposal being made by the Trump administration to replace Obamacare. That said, it does appear that there are many people still in favor of the Obamacare system, despite some of the pitfalls it has on other Americans. In a survey released on Friday, The Kaiser Family Foundation found a lot of bipartisan support for keeping federal funding for Medicaid expansion, which was done through Obamacare.

Eighty-four percent of people who took part in the poll felt it was important to do so. The poll shows that there is major support for the Obamacare law at this point, with many Americans now viewing it favorably due to the help it has provided many Americans nationwide according to the poll. Despite this, many healthcare organizations are in favor of a change from Obamacare with the U.S. Department of Health and Human Services being one of them. Spokeswoman Caitlin Oakley claimed, “Obamacare has failed. We welcome any and all efforts to repeal and replace it that put patients first.”

The situation at hand at this point is if Donald Trump and his administration will end up keeping the base of Obamacare around with changes to help, which is what John Boehner, former house speaker, claimed might happen recently. With Obamacare being loved and hated across the nation, it will be interesting to see what it is replaced with.</s>A leaked “discussion draft” of House Republicans’ Obamacare repeal-and-replace bill surfaced on Friday. The draft reveals important details about the plan being pushed by House GOP leadership, details that weren’t available in a white paper published last week. The question remains: will the House plan pass muster with Congress’ non-partisan budget scorekeepers?

The 106-page discussion draft, dated February 10, was obtained by Paul Demko of Politico. It corresponds reasonably closely to the 19-page outline that House GOP leadership leaked on February 16.

Both documents reflect a shift in strategy for House Republicans. After Donald Trump’s November victory, congressional Republicans were planning a “repeal and delay” strategy in which they first repealed Obamacare’s funding streams, and then worked with Republicans and Democrats to formulate a replacement.

But that strategy was thrown over the transom after enough Republicans raised objections to it. So, congressional leadership moved on to plan B: attempting to enact, through the Senate reconciliation process, a partial replace that could make it through a party-line vote.

The centerpiece of the plan is its attempt to replace Obamacare’s health insurance exchanges with a new program—housed in a new Section 36C of the Internal Revenue Code—that would provide subsidies for Americans to buy any health insurance plan that is legally available in their state.

The plan would enact two key regularly reforms of the individual market for health insurance: it would revert back to states the ability to define the “essential health benefits” that insurers must cover, and it would allow insurers to charge their policyholders a much wider range of prices based on age. (The plan creates a default age ratio of 5:1; i.e., insurers could charge their youngest customers one-fifth of what they charge their oldest ones, and states could widen that ratio even farther if they so chose.)

These are two of the three key regulatory changes that I wrote about last month as necessary for meaningfully lowering premiums. The third, actuarial value, is not directly addressed in the discussion draft.

The draft would replace Obamacare’s means-tested tax credits with tax credits that are not adjusted for income. This is the key flaw in the House leadership plan, because it means that millions of highly vulnerable people—those near the poverty line and those with poor health status—will not receive enough in tax credits to afford the coverage they need.

The draft, for the first time, reveals the size of the subsidies Republicans are considering: a range of $2,000 to $4,000 a year, depending on one’s age.

Those under 30 would get a $2,000 subsidy per year; those aged 30–39 would get $2,500; 40–49, $3,000; 50–59, $3,500; and 60-plus, $4,000. The tax credits would grow annually at inflation (CPI) plus one percent, creating a long-term incentive for insurers and health care providers to keep costs down. The government predicts that CPI will grow at 2.6 percent a year from 2017 to 2025, meaning that these subsidies would grow at 3.6 percent.

It makes sense to adjust the tax credits by age, as older people consume more health care than younger people. But it would have been smarter for Republicans to structure the subsidies in a more linear manner by age; e.g., $3,950 for 59-year-olds, $3,900 for 58-year-olds, and so on, down to $3,550 for 51-year-olds and $3,500 for 50-year-olds.

But Republicans ought to have also adjusted their tax credits by income. Supporters of the flat tax credit, like House Speaker Paul Ryan, argue that a means-tested tax credit is difficult to administer, and it’s true that Obamacare’s version is extremely unstable. But a simpler, easy-to-administer means-tested tax credit can be designed, by using last year’s tax return as the basis for means-testing.

Flat tax credit supporters also claim that a means-tested tax credit discourages people from seeking more work. “A [non-means-tested] credit fixes this unnecessary disincentive to work and makes sure our tax code is built for growth,” House GOP leaders wrote in their February 16 white paper. But the House leadership plan would create a far steeper benefit cliff, because Medicaid enrollees would face a steep loss of benefits the moment they made too much money to remain in Medicaid.

Indeed, the Medicaid-to-tax credit benefit cliff would grow steeper over time, because the Medicaid per-capita cap is set to grow at CPI-M plus one percent (5.2 percent), while the tax credits will grow at CPI plus one percent (3.6 percent).

Put simply: the flat tax credit in the House leadership plan is a critical mistake, one that needs to be corrected if Republicans are going to successfully replace Obamacare.

The House leadership plan would significantly expand the ability of Americans to save money, tax-free, in health savings accounts. Today, individuals are allowed to save $3,400 a year in a tax-free HSA, and families are allowed to save $6,750 a year, so long as they are enrolled in a qualified high-deductible health plan.

The plan nearly doubles those limits, to $6,550 for individuals and $13,100 for families.

The plan contains an interesting twist: it replaces a standard Republican policy, high-risk pools, with “state innovation grants.” The difference? States could use the innovation grants for any purpose they wish. For example, a state could retain Obamacare’s approach to pre-existing conditions—what’s called guaranteed issue—and use the state innovation waiver to provide additional financial assistance through risk adjustment to those who need it.

That’s a much smarter approach than imposing high-risk pools on every state in a one-size-fits-all fashion. Let states figure out whether high-risk pools, or some other mechanism, works best to cover people with poor health status. High-risk pools were never the optimal market-based solution for sick people who are uninsured, and this way, states can prove it.

The discussion draft provides the actual scale of these grants: $15 billion each in 2018 and 2019, and $10 billion a year from 2020 through 2026. States would have to kick in an additional 7 percent of the money to fund these grants in 2020; 14 percent in 2021; 21 percent in 2022; 28 percent in 2023; 35 percent in 2024; 41 percent in 2025; and 50 percent in 2026.

The discussion draft makes two major changes to the Medicaid program.

First, it phases down Obamacare’s Medicaid expansion. States would retain the option to maintain a larger Medicaid program, but the federal government would only fund around 60 percent of the cost, compared to 90 percent under the ACA. That’s a fair way of balancing the interests of states that expanded Medicaid, and want to maintain that expansion, and states that did not, and don’t want to be punished for their fiscal restraint.

Second, it overhauls the pre-Obamacare Medicaid program, by converting it into a system of per-capita subsidies, in which states would receive a fixed dollar amount for each Medicaid enrollee resident within their borders, which they could then use to fund a safety-net health insurance program that they would design and administer.

The size of the per-capita subsidies would be calculated based on average state spending on key Medicaid subpopulations. The per-capita subsidies would grow at rate of the “medical care component of the consumer price index for all urban consumers” (CPI-M) plus one percent; the Centers for Medicare and Medicaid Services predict that CPI-M will grow at 4.2 percent from 2017 to 2025.

The House leadership plan doesn’t go far enough; in an ideal world, we’d take the dollars we spend on Medicaid acute-care insurance (i.e., health insurance for people with incomes below the poverty line) and convert them into refundable tax credits that the poor could use to buy the health care and coverage that they want. If such a system is good enough for people above the poverty line, surely it’s also good enough for people below it.

But the House leadership plan, as is, would amount to the most significant attempt at Medicaid entitlement reform in the program’s history. As the plan notes, nearly 72 million Americans are enrolled in Medicaid, a huge number. And states could, in theory, allow Medicaid enrollees to use their per-capita allotments as if they were refundable tax credits.

How will CBO score this bill?

Speaker Ryan has promised that his team will be producing actual, scoreable legislation very soon. “After the House returns following President’s Day,” he tweeted, “we intend to introduce legislation to repeal and replace Obamacare.”

After Republicans introduce a formal bill, the Congressional Budget Office can score it, estimating its future effects on taxes, spending and the number of Americans with health insurance.

A plan without a means-tested tax credit is almost certain to cover significantly fewer people than the ACA. Every major newspaper will then lead with the story of how the non-partisan CBO has estimated that the GOP plan could throw tens of millions off their health insurance.

Republicans, at that time, will have to decide where they’re ok with that. Here’s betting that they’re not. And once they fix this critical flaw in their discussion draft, they will have developed a transformative piece of legislation that could represent the most significant domestic policy achievement in our lifetimes.

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A leaked memo from House Republicans reveals cutting provisions from Obamacare such as Medicaid expansions and subsidies for health insurance.