Republican presidential candidate Scott Walker's plan for replacing President Barack Obama's health care law would extend refundable tax credits to help pay for private health insurance based on age instead of income, restructure Medicaid and allow people to shop for insurance across state lines.
The Wisconsin governor provided details of his proposal to The Associated Press in advance of a Tuesday speech in suburban Minneapolis where he outlined his first major policy initiative of the presidential campaign.
Walker's plan does not include cost figures or an estimate of the number of people who would be covered, making it nearly impossible to compare with current law. For the period from April to June of this year, 11.4 percent of U.S. adults were uninsured, which translates to about 16 million people gaining coverage since the rollout of Obama's health care law in 2013.
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Walker's campaign said the plan would be paid for by eliminating $1 trillion in taxes that are levied under the current law and by making other changes to Medicaid and how health insurance is taxed.
The Supreme Court in June upheld a key portion of the Affordable Care Act allowing for federal subsidies to defray the cost of coverage, a major defeat for opponents of the law.
Walker and other Republican candidates have insisted they would repeal the law, starting on the first day of a GOP presidency. The biggest hurdle Walker, and any opponent of the law, faces is getting it repealed. That would take 60 votes in the Senate, and Walker's plan does not address how he would undo the law in any other way.
Walker, in excerpts of his speech released by his campaign, blamed fellow Republicans with not doing enough to repeal the law.
"Republican leaders in Washington told us during the campaign last year that we needed a Republican Senate to repeal Obamacare," Walker said in the prepared remarks. "Well, Republicans have been in charge of both houses of Congress since January and there still isn't a bill on the president's desk to repeal Obamacare."
Topher Spiro, vice president for health policy at the Center for American Progress, a think tank often aligned with the White House, said Walker's plan would be a step backward.
"The math only adds up if he's slashing Medicaid and increasing taxes on middle-class people with employer plans," Spiro said.
While the Walker plan would repeal the Affordable Care Act, it appears to use some similar kinds of tools to promote coverage. For example, there would be no requirement for individuals to carry health insurance or face fines, as there is currently. But, in order to be guaranteed affordable coverage without regard to pre-existing medical problems, individuals would have to "maintain continuous, creditable coverage."
Walker would also change one of the most popular parts of the current law requiring insurance companies to allow people up to age 26 to stay on their parents' plan. Under Walker's proposal, states would decide whether to allow it.
There's merit to Walker staking out his position on the issue, even though he doesn't explain how the law would be repealed, said economist Douglas Holtz-Eakin, president of the American Action Forum, a center-right think tank.
"There's a lot of this that is fairly standard conservative health policy reform," Holtz-Eakin said. "The basic plan looks familiar."
Walker, similar to current law, would also provide tax credits to help with the cost of coverage for people whose employers don't offer insurance. But unlike current law, those credits of between $900 and $3,000 would be based on age and not be keyed to a person's income. So they may not help low- to moderate-income people as much as the existing tax breaks do.
Walker's plan calls for eliminating unspecified regulations in the current law, a move that Walker claims would lower premiums by 25 percent.
Other elements of the plan would include extending a $1,000 refundable tax credit for anyone who signs up for a health savings account, allowing people to shop for health insurance across state lines, reorganizing Medicaid into smaller programs, and giving states more regulatory authority.
He would also allow for new health insurance purchasing agreements and deregulate the long-term care insurance market.
The reality of outright repealing the law as Walker wants to do is stark: Doing away with it completely would kick 19 million people off insurance in the first year, according to the Congressional Budget Office.
Walker isn't the first Republican to put forward a detailed plan for replacing Obama's law. Louisiana Gov. Bobby Jindal released his plan last year and Florida Sen. Marco Rubio outlined his approach in an opinion piece published Monday. And while alternatives have been introduced in Congress, none has gotten traction as Republicans have yet to coalesce around any particular idea.