Bush ACA Replacement Plan Offers Tax Credits, More State Control


Jeb Bush’s Obamacare replacement plan offers tax credits, more state control – Modern Healthcare Modern Healthcare business news, research, data and events

Republican presidential candidate and former Florida Gov. Jeb Bush laid out a familiar plan Tuesday for replacing the Affordable Care Act. His plan focuses on catastrophic coverage policies that can be purchased with tax credits for those without employer-sponsored insurance.He joins Sen. Marco Rubio of Florida with a somewhat fleshed-out plan, although neither of them are specific about costs or how many people would be covered.

Bush, like Rubio, calls for tax breaks to help people buy insurance and giving states control of spending Medicaid dollars. Louisiana Gov. Bobby Jindal, who has been relegated to the early time-slot GOP debates for lower polling candidates, has released a plan that calls for tax deductions instead of credits.

Joe Antos, Wilson H. Taylor scholar in healthcare and retirement policy at the American Enterprise Institute, said Bush’s plan isn’t new or radical, but accomplishes most of the goals of his party.

“This is a pretty standard, mainstream Republican plan,” he said.

Bush said Tuesday that the ACA has not lowered costs for consumers and has stifled innovation with too many regulations. He also said the law was written by and for special interest groups.

“There’s no way to fix it, to be honest with you,” he said. “There’s no way to fix something that was a failure from the start.”

Like other plans Republicans, including former Wisconsin Gov. Scott Walker who unveiled a similar plan before leaving the race, Bush’s would repeal the individual mandate, promote health savings accounts and provide tax credits to those who do not get insurance through work. It would also allow companies to sell policies across state lines.

“The possibilities for innovation are endless if we just trust the marketplace to do what it does so well,” he said.

A more detailed plan summary says the tax credits would be based on age and would adjust with inflation. They would be calculated on the average tax benefit received by workers who are covered by their employers. Bush has not said how the tax credits would be paid for.

The plan also says states would receive a single allotment from Medicaid that would be based on the number and risk profiles of vulnerable and low-income people in their states.

Bush touted a pilot program he instituted toward the end of his tenure as Florida governor that allowed insurers to decide which benefits they would offer. He said it provided high quality care at lower prices, although studies show the plans performing worse than the national average and causing consumer confusion.

Antos said Bush’s experience dealing with healthcare in Florida is likely to help more than hurt him. It would be particularly useful going up against another experienced candidate such as Hillary Clinton.

The plan would take at least a few years to implement, even with a smooth political path. There is no short or simple way to repeal the ACA, he said.

“None of this is impossible,” he said. “But quick is not in the vocabulary.”

The most interesting part of Bush’s proposal is the theme of innovation, including modernizing how the Food and Drug Administration approves medicines and promoting the release of some patient data to improve efficiency and value of care, he said.

Bush would replace the ACA’s Cadillac tax with a cap on the employer tax exclusion at $12,000 for individuals and $30,000 for families.

Bush will release a separate plan to “strengthen and secure” Medicare, according to the outline.

Ohio Gov. John Kasich, whom other candidates have criticized for expanding Medicaid in his state, is expected to discuss this week in New Hampshire how he would reform Medicare and Medicaid as president.