The plan, drawn up by the House Republican Study Committee, starts with repealing the 2010 health care reform law. It then aims to lower health care costs through a few mechanisms. Income and payroll tax deductions would be available to individuals ($7,500) and families ($20,000) for health coverage. Insurance plans could be sold across state lines. The federal government would pump $25 billion into state high-risk pools for people with preexisting conditions. Medical malpractice laws would be reformed to reduce doctors' risk of litigation.
As for the merits of the bill itself, it wouldn't do much to help the low-income Americans who make up a substantial portion of the country's 48 million uninsured. First, by repealing Obamacare, it would eliminate income-based aid from Medicaid expansion and premium tax credits for coverage sold on the insurance marketplaces created by the law.
But then by basing aid on tax deductions instead of credits, the Republican legislation would have limited benefits for people whose income is so low that they might pay nothing or little in income taxes.
This doesn't help people who (Obamacare) helps. It helps people who vote Republican. A $20,000 income tax deduction doesn't help you if you're poor enough not to pay income tax. But it helps you a huge amount if you're paying at a very high level.
Experts concur. "House GOP plan to be based on a tax deduction, not a credit?"tweeted Austin Frakt, a health economist at Boston University. "Poor people, meet underside of bus."
Asked about those concerns, Scalise said the bill would lower the overall cost of health care, making coverage ultimately more affordable to the poor. He also said that the payroll tax deductions would still apply and that Obamacare, by putting people near or below the poverty line on Medicaid, wasn't helping them anyway.
"The biggest concern I hear from low-income people that is the impediment for them getting health insurance is the cost. By putting forward solutions that actually lower the cost, it makes health care affordable for millions of people who are right now priced out of the market," Scalise said. "The president's solution is to dump them onto Medicaid. The most broken part of health care in America is Medicaid."
Other elements of the GOP plan have also been questioned. High-risk insurance pools were funded as part of Obamacare, intended to help the transition to the law's 2014 reforms, but turned out to be more expensive than expected. The malpractice reforms being proposed were instituted in Texas, but they have not had a significant effect on health care costs.
And while the Republican proposal would surely be killed in the Senate, the bill might not make it out of the House. Scalise acknowledged to reporters that he had not received a formal commitment from House GOP leadership to have a vote on the bill.