A new Republicans health reform plan – is it for real?

"Repeal and replace" has been the battle cry of Republicans since Obamacare was passed. But while the repeal part is clear enough, the call to replace the law has been short on specifics. Last week, three GOP members of Congress set out to change that by offering elements of an alternative plan.

The proposal was put forward by Senators Orrin Hatch of Utah and Richard Burr of North Carolina and Representative Fred Upton of Michigan. (To read the full proposal, click here.) It includes many elements that Hatch and Burr had proposed a year ago with then-Senator Tom Coburn of Oklahoma.

The plan keeps a few elements of Obamacare but in a severely limited form, and it scraps several core provisions. It keeps the prohibition on lifetime limits on coverage and the requirement that insurers continue coverage of dependants on their parents' policies up to age 26, unless a state opts out.

As under Obamacare, insurers would face limits on the size of the premium differential they could impose between older and younger people, but the ratio is larger - five to one instead of Obamacare's three to one. The proposal also keeps Obamacare's insurance subsidies for those with lower incomes but limits them to incomes below 300% of the federal poverty level rather than Obamacare's 400%.

The biggest departure from Obamacare is the elimination of the expansion of Medicaid. The plan also scraps the mandate on employers to offer coverage. It replaces the mandate on individuals with a rule that you may not be denied a policy or charged more because of a pre-existing medical condition if you have maintained coverage continuously for at least 18 months.

The Republican plan accepts Obamacare's taxation of high-end employer-sponsored insurance policies and even takes it a step further. Instead of a Cadillac tax of 40% on expensive plans, it limits employees' ability to exclude the value of employer contributions from their incomes for tax purposes.

Even though it would have difficulty overcoming a Democratic filibuster in the Senate, the proposal represents some progress. It marks a step toward moving the debate away from simple fault finding with Obamacare to a weighing of alternative approaches.

However, the plan would do almost nothing to expand the number of people with coverage, which is Obamacare's main goal. Obamacare's success so far in bringing down the number of uninsured is primarily due to the Medicaid expansion. And premiums for older people that are five times higher than those for younger people would make coverage unaffordable for many of those who need it most.

But a concrete proposal on how to replace Obamacare may at least open the door to constructive discussion. Calling for repeal with no alternative gets the public debate nowhere.

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