So What Actually Comes After Obamacare?

There are a lot of theories on what happens to replace Obamacare when Republicans eagerly kill it next year, but they know that they own whatever remains.  Still, that has an actual process too, and Vox's health care writer Sarah Kliff goes over the various proposals.

If there’s one thing Republicans have been clear about for the past six years, it is that the top of their agenda includes repealing Obamacare. 

But Obamacare repeal would leave an estimated 22 million Americans without coverage and wreak havoc on the individual insurance market. It’s becoming increasingly clear that Republicans can’t just repeal Obamacare — they need to replace it with something. 

It turns out Republicans have a lot of choices: There are at least seven different replacement plans that Republican legislators and conservative think tanks have offered in recent years. I’ve spent the past week reading them, and what I’ve learned is this: 

• Yes, Republicans have replacement plans. It is true that the party has not coalesced around one plan — but there are real policy proposals coming from Republican legislators and conservative think tanks. There is a base that the party can work from in crafting a replacement plan.
• There is significant variation in what the plans propose. On one end of the spectrum, you see plans from President-elect Donald Trump and Sen. Ted Cruz that would repeal Obamacare and replace it with virtually nothing. On the other end of the spectrum, there are plans from conservative think tanks that go as far as to keep the Affordable Care Act marketplaces and continue to give low-income Americans the most generous insurance subsidies.
• If we can say one thing about most Republican plans, it is this: They are better for younger, healthy people and worse for older, sicker people. In general, conservative replacement plans offer less financial help to those who would use a lot of insurance. This will make their insurance subsidies significantly less expensive than Obamacare’s.
• Economic analyses estimate that these plans reduce the number of Americans with insurance coverage. The actual amount varies significantly, from 3 million to 21 million, depending on which option Republicans pick. They will near certainly provide more coverage than Americans had before Obamacare, but also less than what exists currently under the health law.

I’ve spent the past week talking to authors of Republican replacement plans, economists who support them, and economists who oppose them. I’m focusing here on the two plans that are likeliest to be the most influential in the coming replacement debate: Better Way, from House Speaker Paul Ryan (R-WI), and the Patient CARE Act, from Sen. Orrin Hatch (R-UT), who chairs the Senate Finance Committee.

Kliff goes on to explain the differences in these multiple plans, but on the spectrum that the GOP has, it's only a question of how much worse the replacement will be than the current Affordable Care Act. Paul Ryan's plan would eliminate health care coverage for at least 18 million people, and Orrin Hatch's plan would cause anywhere from 4 to 9 million people to lose coverage.

Other plans are either better or worse than this, but again, it's only a question of how many people lose coverage and all the plans get rid of the ACA's medical bankruptcy protection.  Nearly all the plans get rid of covering pre-existing conditions in some way as well.

In other words, it's a question of how badly this goes, and how quickly it happens.  If you thought Obamacare was bad, all the Republican alternatives are going to be worse.

But emails, right?