Speaker Ryan's alternative to Obamacare: roadmap for Republicans?

Paul Ryan and his Republican colleagues unveiled a healthcare agenda to replace Obamacare, but the presumed Republican presidential candidate remained quiet about whether he supports it.

Even as Republicans have tried to do away with Obamacare, attempting more than 60 times to repeal or undermine it, they have never agreed on how to replace it.

They will soon, at least according to House Speaker Paul Ryan of Wisconsin and his Republican colleagues. 

Speaker Ryan, the House's highest-ranking Republican, unveiled an agenda Wednesday to replace parts of the Affordable Care Act, while retaining its most popular features. The plan is part of Ryan's and his colleague’s six-point agenda, "A Better Way" to preview a future with a Republican Congress, and perhaps a Republican president, as the Christian Science Monitor's Francine Kiefer writes.

Yet it’s unclear if all of the Republican Party, including Donald Trump, will unite behind the proposal, especially as Ryan has found it difficult sharing the microphone with the presumptive nominee at center stage.  

Kathleen Hall Jamieson, director of the Annenberg Public Policy Center of the University of Pennsylvania, says the Republican Party can rally around Ryan's agenda. "Tactically, this is a smart communication move," Dr. Jamieson tells The Christian Science Monitor in a phone interview Wednesday. “It is policy oriented, and very straightforward.”

It tells voters "this is what we as Congress stand for," says Jamieson, “in an era and in a time when it’s very easy to hear the Republican Party’s prospective nominee attack without consequential policy alternatives."  

Ryan’s plan is a "roadmap" for how the Republicans would replace the Affordable Care Act, as one Republican aide described it, providing background to reporters. Details and legislation will follow, they said.

There are parts of the Affordable Care Act Ryan and the other authors of the 37-page paper would replace. The plan relies on individual tax credits to allow people to buy coverage from private insurers, according to the Associated Press. It would allocate $25 billion to high-risk pools for those with preexisting conditions and others, and transform the Medicaid program into state block grants or individual per-capita allotments. Insurers could sell across state lines and medical liability laws would be reformed, according to Politico.

The most popular parts of Obamacare would remain in place, however. Namely, adults would be able to remain on their parents’ plans until they’re 26, and patients with preexisting conditions would be protected.

But the agenda fails to offer details, like how much these reforms would cost, the size of the tax credits, and how many people will be covered.

Ever since the Affordable Care Act was adopted, Republicans have vowed to replace it. Their only problem was they couldn’t agree on how. "Conservative factions have blasted plans deemed to provide too much coverage – such as Scott Walker’s prescription when he was running for president – as ‘Obamacare Lite.’ At the other end of the spectrum, moderate Republicans have criticized plans that offer too little coverage as unsympathetic to people with expensive pre-existing illnesses," writes Politico's Jennifer Haberkorn.

"Republicans have put forward ideas ranging from complete alternatives to targeted, issue-specific proposals," write the authors. "The plan presented here unites these efforts under one complete vision that successfully reforms America’s health care system."

Lanhee Chen, a fellow at Stanford University’s Hoover Institution and a member of President Obama’s Social Security Advisory Board, says the plan Ryan and his colleagues proposed is the "best chance the party has to unite behind a market-based alternative to Obamacare." 

"The vast majority of conservatives would be thrilled to have the Ryan alternative," writes Mr. Chen, in an email to the Monitor Wednesday. "Donald Trump would be smart to embrace the plan, particularly given that he hasn't put forward an Obamacare alternative of his own."

Mr. Trump has said he will replace Obamacare with "something terrific," but has offered little more than a rough sketch on his website. The plan Ryan released incorporates parts of Trump’s proposal, including Medicaid block grants to states and the ability for insurers to sell across state lines.

But Trump has remained mum about whether he supports this or any of the six points on the "Better Way" agenda. The Trump campaign did not reply for a comment when emailed by the Monitor Wednesday.

Trump and Ryan’s relationship remains ambiguous. Although Ryan has publicly endorsed Trump, he encouraged House Republican to vote their "conscience."

Perhaps, the agenda is Ryan and his colleagues’ way of assuring Republicans they can vote for Republicans on the rest of the ballot even if they don’t don't vote for Trump, says Jamieson of the University of Pennsylvania.

"It puts Ryan as alternative face of Republicans versus Trump," she says. "That’s important if they’re trying to preserve the House and Senate."