Comparison of 6 Proposed ACA Replacements

The Kaiser Family Foundation just published a comparison of six proposed replacements to the ACA.  The issue brief spells out changes to Medicare that would result if each of these proposed replacements to the ACA went into effect.

A few interesting things to note across the six bills:

• Three proposals would repeal the ACA creation of the CMMI
• Two proposals would repeal the ACA phasing out of the Part D Coverage Gap
• Four would repeal the ACA fee on branded drug manufacturers; one does not specify

There are also a few positive ideas:

• One would consolidate all MSPs and require states to have a uniform eligibility test for them.  QMB, SLMB, and QI as they currently exist are unnecessarily complex.
• Two would combine Medicare A and B deductibles and out of pocket limits. If done right, this could bring some positive aspects of Part C to traditional Medicare.

Finally, one would limit the amount that could be charged to patients, including Medicare beneficiaries, for out-of-network emergency care.  Traditional Medicare beneficiaries have protections against this already - providers who do not accept assignment from Medicare may only bill the patient up to 15% more than the Medicare approved amount for most charges.  These are called legitimate excess charges.

Overall, these proposals are mostly leaving ACA Medicare benefits alone, such as covering preventive services in full - only two are specifically repealing all ACA Medicare provisions.  However, most of them are repealing ACA sources of revenue including repealing taxes and fees on drug manufacturers, health insurers, and high-earning individuals.