GOP Plans to Replace Health Care Law With ‘Universal Access’

House Republicans, responding to criticism that repealing the Affordable Care Act would leave millions without health insurance, said on Thursday that their goal in replacing President Obama’s health law was to guarantee “universal access” to health care and coverage, not necessarily to ensure that everyone actually has insurance.

In defending the Affordable Care Act, the Obama administration, congressional Democrats and advocacy groups have focused on the 20 million people covered by the law, which has pushed the percentage of Americans without health insurance to record lows. The American Medical Association recently said that “any new reform proposal should not cause individuals currently covered to become uninsured.”

But House Republicans, preparing for a rapid legislative strike on the law next month, emphasize a different measure of success.

“Our goal here is to make sure that everybody can buy coverage or find coverage if they choose to,” a House leadership aide told journalists on the condition of anonymity at a health care briefing organized by Republican leaders.

Republicans have an “ironclad commitment” to repeal the law, the aide said, as lawmakers moved to discredit predictions that many people would lose coverage.

“There’s a lot of scare tactics out there on this,” said Representative Kevin Brady, Republican of Texas and chairman of the Ways and Means Committee. “We can reassure the American public that the plan they are in right now, the Obamacare plans, will not end on Jan. 20,” the day Donald J. Trump will be inaugurated.

The suggestion that 20 million people will lose coverage is a “big lie,” Mr. Brady said, after meeting here with Republican members of his committee.

“Republicans,” he said, “will provide an adequate transition period to give people peace of mind that they will have those options available to them as we work through this solution.”

Republicans have not settled on the details or the timing of their replacement plan. The House speaker, Paul D. Ryan of Wisconsin, portrays repeal of the law not as an ideological crusade, but as a form of urgently needed relief.

“Insurance markets are collapsing,” Mr. Ryan said this week. “Premiums are soaring. Patients’ choices are dwindling.”

The House leadership aide said that repealing major provisions of the law was a priority for the first 100 days of the Trump administration. But, he said, the date that those provisions would actually disappear would be delayed, allowing a transition period as short as two years or as long as three or four years. During that time, Republicans plan to pass one or more replacement bills.

By giving people the choice to buy insurance, Republicans could end up dangerously skewing the health insurance market, Obama administration officials and insurance executives say. Sick people are more likely to sign up, they say, and there may not be enough healthy people paying premiums to cover the costs for those who are less healthy.

Under the Affordable Care Act, people who go without insurance are subject to tax penalties. The Internal Revenue Service says that more than eight million tax returns included penalty payments for people who went without coverage in 2014.

The House leadership aide said that lowering the cost of insurance was a much better way to encourage people to opt in.

“We would like to get to a point where we have what we call universal access, where everybody is able to access coverage to some degree or another,” the aide said. “Over the past six years, if you look at the experience we’ve had with the A.C.A. rollout, chasing coverage doesn’t necessarily yield great outcomes. You can have people going into an exchange, finding out that their pediatrician is no longer available to them.”

The aide said House Republicans had not decided on the future of cost-sharing subsidies that are paid by the federal government to insurance companies. Such subsidies are intended to reduce out-of-pocket costs for millions of low-income people buying insurance under the Affordable Care Act.

A federal district judge, responding to a lawsuit filed by the House, ruled in May that the Obama administration had paid billions of dollars to insurers since January 2014 even though Congress had not appropriated money for such “cost-sharing reductions,” and that the payments therefore violated the Constitution. Without that money, estimated at $130 billion over 10 years, insurers would increase premiums or pull out of the insurance exchanges, creating chaos for consumers, some health policy experts say.

But now that the House leadership has won a legal victory, Republicans have not decided how to proceed. The aide declined on Thursday to say if Republicans would seek an immediate halt to the cost-sharing subsidy payments. He did not rule out the possibility that a Republican-controlled Congress might keep the money flowing for a transition period, to stabilize the market while Republicans develop alternatives to the health law.

“It’s an open question,” he said.

Republicans said they were more interested in vindicating Congress’s constitutional power of the purse.

In any event, the House leadership aide said, Republicans do not intend to pull the rug out from people who have gained insurance under the Affordable Care Act.

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