As the incoming Congress and administration develop plans to “repeal and replace” the Affordable Care Act (ACA), analysis of five earlier repeal and replace proposals provides insights into the key features likely to appear in any forthcoming repeal and replace legislation. Manatt analyzed Speaker Paul Ryan and the House Republican Caucus’s 2016 proposal, legislation sponsored by House Budget Committee Chairman Tom Price, President-elect Trump’s nominee to lead Health and Human Services, a proposal co-sponsored by Senators Orrin Hatch and Richard Burr and Representative Fred Upton, as well as a proposal from the Heritage Foundation. We also analyzed the reconciliation bill (H.R. 3762) passed and vetoed earlier this year, noting the areas that were and those that were not addressed in that reconciliation bill. (Many of the excluded provisions are assumed to be outside of the scope of reconciliation.) The proposals range from a 242-page draft of legislation sponsored by Representative Price to an 8-page concept paper published by Senators Hatch and Burr and Representative Upton. Across these different formats there was significant variation in the level of detail, with some proposals providing answers to key policy questions and others merely outlining an approach.

Despite the differences in the breadth and depth of the proposals, they shared several common features—and had some key differences—on how to modify the ACA’s commercial market reforms. The proposals generally modify or eliminate federal reforms. All proposals revise and reduce the tax credits and federal funding for healthcare coverage, which might limit state choices even in the states that would want to retain some ACA consumer protections.